Clinical complications can occur in OCD

Although rare, severe clinical complications can occur in obsessive compulsive disorder, authors of a case report conclude. Writing in General Hospital Psychiatry, the authors describe a 41-year-old single unemployed man who first presented at the age of 12 with obsessive– compulsive symptoms characterized by cleaning and ordering/ symmetry rituals. Seventeen years later, he developed doubts regarding the shape of the bones and cartilages of his body and a need to touch them repetitively. Initially, he touched his nose, then hands and fingers, neck, legs and knees. Next, he began to touch his eye cavities to “understand” their exact format and angles. The patient developed glaucoma in the left eye that led to impairment in his optic nerve and complete visual loss. In his right eye, the cornea was injured, also leading to important impairment in his visual acuity. When the patient first presented to the psychiatric department of the authors he was taking antidepressant, neuroleptic and benzodiazepine medications. During his first consultation, the neuroleptic was suspended; sertraline changed to paroxetine (40 mg/d), oxcarbazepine (300 mg/d) was initiated and alprazolam (2 mg at night) was maintained. After 1 month, the patient presented with irritability, increased energy, sexual desire and speech, with no modification in the OC symptoms. The dose of oxcarbazepine was raised to 600 mg/d and the dose of paroxetine was reduced to 20 mg/d. Two weeks later, he was euthymic, speaking properly and reporting a mild improvement in his compulsions. However, the patient did not continue with treatment, probably, the authors said, because of interference of family members, who showed inappropriate attitudes and conflicting relationships. The authors said their case report contributes to the important but neglected discussion concerning self-mutilation behaviours in OCD. “Cases like this demand that psychiatrists and other medical specialists work closely together to try achieve a better prognosis for both mental and physical symptoms, which also affect family members,” they concluded....