scholarly journals Obsessive compulsive disorder: a case of extreme obsessional slowness in an 18-year-old presenting to the national OCD unit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S115-S115
Author(s):  
Claire Fischer ◽  
Ilenia Pampaloni ◽  
Sarah Gardiner
Keyword(s):  
Normal Development ◽  
Treatment Approach ◽  
Exact Nature ◽  
Obsessive Compulsive ◽  
Juvenile Onset ◽  
Compulsive Disorder ◽  
Communication Difficulties ◽  
Fdg Pet Scan ◽  
History Of ◽  
Stooped Posture

ObjectiveObsessional slowness in OCD is a rare phenomenon on which there is minimal published literature. This is a particularly severe and atypical case of early onset OCD with extreme obsessional slowness and mutism. To the best of our knowledge, there have been no reports of similar severity published in this age group. This report seeks to provide discussion of important organic causes that may need to be considered as well as information on treatment approach.Case reportAn 18-year-old male was admitted to the National OCD Unit, Springfield Hospital with a history of autism and normal development until the age of 14, after which symptoms of OCD with fear of contamination emerged, followed by progressive motor slowness and mutism.Due to the severity of OCD and self-neglect he had two previous admissions to CAMHS wards and required a course of ECT to treat catatonic symptoms age 17.Pharmacological treatment has included Aripiprazole 5 mg and Fluoxetine 60 mg, which the patient was taking at admission. The latter was subsequently switched to Sertraline 250 mg and Aripiprazole increased. As it was hypothesized that his obsessional slowness stemmed from severe levels of anxiety, Buspirone was also added.Therapy has been intensive, although communication difficulties have made targeting specific fears challenging as the exact nature of the intrusive thoughts remains unclear.DiscussionFollowing combined neurology and neuropsychiatry review, the patient spent four weeks in a general hospital for further investigation as it was initially felt an organic cause was likely. Initial differentials included Juvenile Onset Parkinson's or Wilson's disease. Both were subsequently ruled out and despite multiple investigations, no obvious organic cause was found. A markedly abnormal FDG PET scan showed findings usually seen in advanced dementia, but not necessarily clinically correlating to his current presentation.The OCD unit have continued to provide intensive input and tailored treatment programme, encouraging actions against any rules he has in place. Prompting and pacing, verbal exercises and regular stretching exercises due to stooped posture which he attributed to needing to obey certain rules have been used.ConclusionIt is important for clinicians to be aware of obsessional slowness in OCD and this report highlights a particularly rare and severe example in a young adult who has been difficult to treat. Organic causes may need to be considered and MDT approach to treatment is essential.

How athletes coped with COVID-19 restrictions: differences between Switzerland and Italy

2020 ◽  
Keyword(s):  
Psychological Symptoms ◽  
Training Session ◽  
Coping Resources ◽  
Government Officials ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Aggressive Action ◽  
History Of ◽  
Global Threat ◽  
Sport Facilities

The ongoing COVID-19 pandemic is a global crisis of unprecedented scale in modern times. The initial outbreak of COVID-19 in Wuhan spread rapidly, affecting other parts of China and soon other countries becoming a global threat. [1] On 11 March 2020, the WHO has declared the ‘Pandemic state’ calling the governments to take ‘urgent and aggressive action’ to delay and mitigate the peak of infection. To respond to COVID-19 public health experts and government officials are taking several measures, including social distancing, self-isolation, or quarantine; strengthening health facilities to control the disease; and asking people to work at home. To safeguard the health of athletes and others involved all forms of organized sport have been either cancelled or postponed. These range from mass participation events such as marathon races to football league and even to the Olympics and Paralympics that for the first time in the history of the modern games, have been postponed, and will be held in 2021. All sport in Italy had been suspended from early March and from April the lockdown measures had been extended to the training session for professional and non-professional athletes within all sport facilities. Unlike Italy, the Swiss government has not imposed a general curfew so athletes continued to train outdoor although training in a group was forbidden. [2,3] Some athletes in this situation will be able to build on existing coping resources while others athletes may experience psychological symptoms including fear of being infected, anxiety of physical recovery if infected, disturbed sleep, eating disorders, obsessive-compulsive disorder, and family conflicts.

scholarly journals “This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Godwin Tong ◽  
Kieran Groom ◽  
Louisa Ward ◽  
Muhammad Naeem
Keyword(s):  
Case Report ◽  
Mental State ◽  
Young Male ◽  
Obsessive Compulsive ◽  
Psychiatric Admission ◽  
Compulsive Disorder ◽  
Psychiatric Setting ◽  
Patient Reported ◽  
History Of ◽  
Core Symptoms

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

PROLACTIN IN CHILDHOOD OBSESSIVE-COMPULSIVE DISORDER: CLINICAL CORRELATES AND RESPONSE TO CLOMIPRAMINE

PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 992-992
Author(s):  
Gregory L. Hanna ◽  
James T. MCCracken ◽  
Dennis P. Cantwell
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Tic Disorder ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Serotonergic Receptors ◽  
Duration Of Illness ◽  
Chronic Tic Disorder ◽  
History Of ◽  
Clomipramine Treatment

Basal prolactin concentrations were measured before treatment in 18 children and adolescents with obsessive-compulsive disorder as well as in 15 of these patients after 4 and 8 weeks of clomipramine treatment. Basal prolactin levels were influenced by a history of chronic tic disorder and by the duration and severity of obsessive-compulsive symptoms. Clomipramine administration significantly increased basal prolactin levels. A slight decline in prolactin levels during the last 4 weeks of clomipramine treatment was positively correlated with a favorable treatment response and negatively correlated with duration of illness. If the changes in prolactin levels observed during clomipramine treatment are due primarily to changes in serotonergic neurotransmission, these data suggest that clomipramine treatment of obsessive-compulsive disorder produces an adaptive decrease in the responsiveness of serotonergic receptors.

Admixture analysis of age at onset in obsessive–compulsive disorder

2005 ◽  
Vol 35 (2) ◽  
pp. 237-243 ◽  
Author(s):  
RICHARD DELORME ◽  
JEAN-LOUIS GOLMARD ◽  
NADIA CHABANE ◽  
BRUNO MILLET ◽  
MARIE-ODILE KREBS ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Late Onset ◽  
Age At Onset ◽  
Admixture Analysis ◽  
Obsessive Compulsive ◽  
General Anxiety Disorder ◽  
General Anxiety ◽  
Compulsive Disorder ◽  
History Of ◽  
Best Fitting

Background. Age at onset (AAO) has been useful to explore the clinical, neurobiological and genetic heterogeneity of obsessive–compulsive disorder (OCD). However, none of the various thresholds of AAO used in previous studies have been validated, and it remains an unproven notion that AAO is a marker for different subtypes of OCD. If AAO is a clinical indicator of different biological subtypes, then subgroups based on distinct AAOs should have separate normal distributions as well as different clinical characteristics.Method. Admixture analysis was used to determine the best-fitting model for the observed AAO of 161 OCD patients.Results. The observed distribution of AAO in OCD is a mixture of two Gaussian distributions with mean ages of 11·1±4·1 and 23·5±11·1 years. The first distribution, defined by early-onset OCD, had increased frequency of Tourette's syndrome and increased family history of OCD. The second distribution, defined by late-onset OCD, showed elevated prevalence of general anxiety disorder and major depressive disorder.Conclusions. These results, based on a statistically validated AAO cut-off and those of previous studies on AAO in OCD, suggest that AAO is a crucial phenotypic characteristic in understanding the genetic basis of this disorder.

Differentiating Autism Spectrum Disorder and OCD

2017 ◽  
Author(s):  
Robert E. Accordino ◽  
Philip Bartel ◽  
Isobel W. Green ◽  
Christen L. Kidd ◽  
Christopher J. McDougle
Keyword(s):  
Autism Spectrum Disorder ◽  
Autistic Traits ◽  
Autism Spectrum ◽  
Repetitive Behaviors ◽  
Spectrum Disorder ◽  
Obsessive Compulsive ◽  
Communicative Behavior ◽  
Compulsive Disorder ◽  
Communication Difficulties ◽  
Social Communicative

This chapter explores the overlapping clinical presentation and shared genetics and neurobiology of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD). ASD often presents with repetitive behaviors reminiscent of OCD, whereas OCD, at times, can include autistic traits involving social and communication difficulties. This can lead to difficult diagnostic distinctions, which can at times have relevance to treatment. The distinction between compulsions and autistic stereotypies merits particular discussion. Clinical features that should lead to exploration of a diagnosis of ASD include stereotypies such as hand flapping, body rocking or twirling; fixed interests or preoccupations that are ego-syntonic; and impaired social-communicative behavior.

Impulsiveness in Obsessive-Compulsive Patients

1983 ◽  
Vol 143 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Rudolf Hoehn-Saric ◽  
Vernon C. Barksdale
Keyword(s):  
Interpersonal Relationships ◽  
Impulse Control ◽  
Learning Problems ◽  
Eysenck Personality Questionnaire ◽  
Obsessive Compulsive ◽  
Frustration Tolerance ◽  
Compulsive Disorder ◽  
History Of ◽  
Neuroticism Scale ◽  
Low Frustration Tolerance

SummaryObsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.

Cognitive-Behavioural Treatment of Culturally Bound Obsessional Ruminations: A Case Report

1994 ◽  
Vol 22 (4) ◽  
pp. 325-330 ◽  
Author(s):  
Gregoris Simos ◽  
Evangelos Dimitriou
Keyword(s):  
Personal Responsibility ◽  
Clinical Problem ◽  
Accidental Death ◽  
Obsessive Compulsive ◽  
Behavioural Treatment ◽  
General Psychopathology ◽  
Compulsive Disorder ◽  
Cognitive Behavioural Treatment ◽  
Cognitive Behavioural ◽  
History Of

Therapeutic management of obsessional ideas without compulsions is considered to be a rather difficult clinical problem. This report discusses the case of a 24-year old lady with a nine year history of recurrent Obsessive-Compulsive Disorder which most recently presented with a year-long obsessional rumination concerning her superstitious personal responsibility for the accidental death of her cousin. Repeated audio-taped listening to the cognitively restructured content of her obsession resulted both in a rapid elimination of her ruminations and the alleviation of her depressive and general psychopathology.

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