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OCD 1
- 1. Obsessive Compulsive Disorder CasePresentation Supervised by: Brig. Farrukh Saleem Prepared by: Wahaj Ahmad 94 Yumna Asmaa 95 Zainab Hassan 96 Zainab Bashir 97
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- 3. Patient’s Particulars • Name:XYZ • Age: 18 years • Gender: Male • Occupation: Student • Marital status: Single • Religion: Islam • Residence: Falcon colony, Lahore
- 4. Mode of Referral •Date of Admission: 29 April 2014 • Voluntary Admission via OPD • Accompanied by his father
- 5. Presenting Complaints • Repetitivethoughts & compulsive acts: 6 years • Suicide attempts: 2 weeks prior to admission “I had died”
- 6. History of PresentingIllness • Repetitive thoughts of uncleanness after urination • Had to take bath and wash his clothes • Repetitive thoughts & compulsive acts of rearranging books & other things • Repetitive clicking of pen • Unable to study , frustration
- 7. • Approached psychiatrist1 year ago • Diagnosed with Obsessive compulsive disorder • Prescribed FLUVOXAMINE 200mg O.D • Discontinued medication after 2½ months • Reasons for non compliance not known
- 8. • Symptoms intensifiedthis year during exams • Problems during studying • Frustration • Depression “ There is nothing left for me in the world” • Thought & planned suicide
- 9. • 5 attemptsof suicide 1. Tried to cut his wrist 2. Copper sulphate: pinch 3. Paracetamol: 15+15 tablets 4. Mercury: small amount 5. Cyanide: ¼ bottle • None successful
- 10. Suicidal Risk Assessment •Sex (M>F) • Age • Depression • Previous attempts • Ethanol/ drug abuse • Rational thinking • Social support • Organized plan • No spouse • Sickness 9/10 (very High)
- 11. Past History • Nopast history of psychiatric disorder • Substance abuse: • Cigarette smoking: 2010; 1 pack/ day ; quitted in 2011 • Vodka: 2010; 3 units of alcohol/day; 2-3 months • Marijuana: 2011; occasional • Medical & surgical illness • Typhoid; 2005 • Dehydration; 2006 • Asthma; 2005 onwards
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- 13. Personal History • Normalbirth & developmental history • Schooling: • Started at age of 4 • Above average student & respectable relation with teacher • Studies affected by OCD
- 14. Pre-morbid Personality • Attitudetowards: • Self; over concerned with bodily functions • Others; friendly • Religion; compliant, hafiz e Quran • Mood: optimistic, lively • Reaction pattern to stress: frustration
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- 16. • Appearance: • Youngboy of athletic built • Dressed appropriately • Well kempt • Oriented in time place and person • Behavior: • Normal psychomotor activity & gait • Adequate eye contact • Rapport • Attentive • Irritable towards fellow patients • Respectful and friendly towards physician
- 17. • Speech: • Talkative •Prompt • Coherent • Relevant • Mood: • Objective: perplexed & elated • No diurnal variation • Affect: appropriate to content • Subjective: irritable • Suicidal ideation: present
- 18. • Thoughts • Speed:normal • Content: • preoccupied with disease • Obsessive and compulsive thoughts • Suicidal ideas • Able to deal with concept • Abstract thinking • Perception: • No illusions & hallucinations
- 19. • Cognitive Examination •Intact & with in normal range • Insight • Level 5; intellectual insight
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- 22. Yale-Brown Obsessive CompulsiveScale(Y-BOCS) • Obtained score: 24 • Interpretation: severe (24-31)
- 23. Beck Depression Inventory (BDI) Obtainedscore: 31 Interpretation: moderate depression
- 24. Beck Suicide Intent Scale(BSIS) Obtained score: 21 Interpretation: severe suicidal ideation
- 25. 16 Personality Factors (16PF) •Emotionally unstable • Glum & silent • Dull, low
- 26. Psychometric analysis • Y-BOCS:severe obsessions & compulsions • BDI: moderate depression • BSIS: severe suicidal ideation
- 27. Obsessive Compulsive Disorderwith High Suicidal Risk DEFINITIVE DIAGNOSIS
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- 29. Management • Treated indoordue to high risk situation • High risk safety plan • Situation was explained in detail to the parents • Supportive counselling • Psychoeducation • Pharmacotherapy • Fluvoxamine 300mg • ECT under G.A after written informed consent
- 30. • After 4thECT, achieved considerable improvement • After 1 month of treatment, there was decrease in suicidal ideation & OCD symptoms • Improvement in sleep & appetite • Discharged with weekly follow-up visits in psychiatry OPD