Obsessive-Compulsive disorder

Fixated

Step 1: View clinicals

A 68 year old man complains of feeling strong urges to "know" information related to names of people, places or products, starting from 2 years ago. He frequently telephones his friends, relatives, and libraries disregarding the time of day or expense, and has become inquisitive to the point of being unable to engage in social interactions without annoying other people. He also became worried that he was losing his memory, and was compelled to create lists of data to aid his memory. His medical history is remarkable for long standing hypertension and diabetes. He denies substance abuse, while there is no family history of psychiatric disease.


Step 2: Order all relevant investigations

Mini Mental State Examination

MMSE Score: 28/30 (due to a single error of recall, and the inability to draw pentagons properly)

Beck Depression Inventory

The Beck Depression Inventory Score is 14/63 (mild depression)

Yale-Brown Obsessive-Compulsive Scale

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Score: 24/40

CT Brain

The CT scan of the brain reveals a minute hypodense area in the right posterior frontal lobe, which is suggestive of a previous infarct.


Step 3: Select appropriate management

Rivastigmine
Fluoxetine
Cognitive Behavioral Therapy
Psychosurgery


Score: ★★☆