Obsessive-compulsive disorder in disguise—Case report

John E. Berg, Jorid Grimeland

Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway.

DOI: 10.4236/ojpsych.2012.23026                

Abstract

Obsessive-compulsive disorder (OCD) may mimic other minor and major psychiatric disorders or symptoms. Psychomotor disturbances may also be seen in OCD. Symptoms and complaints could be misinterpreted. Differential diagnostic assessments would be difficult either if the person has OCD or another diagnostic entity with OCD related symptoms. If clinicians in residential or outpatient settings do not realize this, the patients may suffer from inadvertent pharmacological treatment efforts, to no avail. A representative case of the former is presented. Withdrawal of all psychotropic medications cold turkey did not increase symptom load during the following weeks, indicating little benefit from medications. Because of continued complaints from the patient, psychotropic medications were gradually reintroduced, without any improvement. OCD patients may not be helped by extensive use of psychotropics and doctors responsible for them should employ other methods of reducing OCD symptoms than lumping together diverse psychotropics. There is evidence for the value of intensive cognitive behaviour therapy, but also for addressing the social conditions of the patients.

Keywords

Obsessive-Compulsive Disorder; Medication; Ward Atmosphere

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Hymas, N., et al. (1991) The neurology of obsessional slowness. Brain, 114, 2203-2233. doi:10.1093/brain/114.5.2203
[2]	Anand, N., et al. (2011) Cognitive behavior therapy in medication non-responders with obsessive-compulsive disorder: A prospective 1-year follow-up study. Journal of Anxiety Disorders, 7, 939-945. doi:10.1016/j.janxdis.2011.05.007
[3]	Patel, S.R. and Simpson, H.B. (2010) Patient Preferences for OCD treatment. Journal of Clinical Psychiatry, 71, 1434-1439. doi:10.4088/JCP.09m05537blu
[4]	Masi, G., et al. (2010) Aripiprazole augmentation in 39 adolescents with medication-resistant obsessive-compulsive disorder. Journal of Clinical Psychopharmacology, 30, 688-693. doi:10.1097/JCP.0b013e3181fab7b1
[5]	Speismann, B.B., Storch, E.A. and Abramowitz, J.S. (2011) Postpartum obessive-compulsive disorder. Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN), 40, 680-690. doi:10.1111/j.1552-6909.2011.01294.x
[6]	Berle, J.O. (1999) Severe postpartum depression and psychosis—When is electroconvulsive therapy the treatment of choice? Tidsskrift for Den Norske Legeforening, 119, 3000-3003.
[7]	Geller, P., Klier, C. and Neugebauer, R. (2001) Anxiety disorders following miscarriage. Journal of Clinical Psychiatry, 62, 432-438. doi:10.4088/JCP.v62n0606
[8]	Mavrogiorgou, P., Illes, F. and Juckel, G. (2011) Perinatal obsessive-compulsive disorder. Fortschritte der Neurologie—Psychiatrie, 79, 507-516. doi:10.1055/s-0031-1281597
[9]	Kuelz, A., Hohagen, F. and Voderholzer, U. (2004) Neuropsychological performance in obsessive-compulsive disorder: A critical review. Biological Psychiatry, 65, 185-236. doi:10.1016/j.biopsycho.2003.07.007
[10]	Chamberlain, S. and Menzies, L. (2009) Endophenotypes of obsessive-compulsive disorder: Rationale, evidence and future potential. Expert Review of Neurotherapeutics, 9, 1133-1146. doi:10.1586/ern.09.36
[11]	Krishna, R., et al. (2011) Neuropsychological performance in OCD: A study in medication-naive patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 35, 1969-1976. doi:10.1016/j.pnpbp.2011.09.009
[12]	Berg, J.E. (2010) Is detoxification or tapering of benzodiazepine abuse advisable in an acute psychiatric clinic? Clinical Neuropsychiatry, 7, 18-21.
[13]	Kumawat, B., et al. (2007) Wilson’s disease presenting as isolated obsessive-compulsive disorder. Indian Journal of Medical Sciences, 61, 607-610. doi:10.4103/0019-5359.37047