2 results
Full Remission of Obsessive Compulsive Disorder (OCD) Symptoms in Huntington's Disease (HD) Using Fluoxetine
- Mithun Devasia, Praveen Kumar, Abdurazak Kottelassal
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S125
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
HD is an autosomal, dominantly inherited, neurodegenerative disorder which can present with cognitive, motor and behavioural symptoms. Recent studies suggest that obsessive compulsive disorder (OCD) symptoms, although not common, may precede or coincide with symptoms in patients with HD. We present a case of an adolescent boy presenting with symptoms of OCD, for 4 months duration, in background of three years diagnosis of HD.
MethodsA 15-year-old boy from South India, presented with recurrent, intrusive thoughts of sexual content, consistent with obsessions and some instances of compulsions in the form of avoiding to do deviant sexual act like fetishism, and having excessive worries about an act he had done earlier for 3 months duration (supported by high scores on Yale-Brown Obsessive Compulsive Scale; Y-BOCS). Patient had normal birth and development and had no past history of psychiatry disorder, however there was family history of HD in multiple first and second-degree relatives. He was on treatment for movement symptoms of HD, diagnosed 3 years back and was on Tetrabenazine for 2 years. Initial psychiatric assessment found the symptoms to be consistent with OCD due to Huntington's disease, according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The patient was admitted to the mental health unit and was started on Fluoxetine, titrated to a dose of 20mg daily for symptoms of OCD.
ResultsSubject showed an excellent response to fluoxetine with complete remission of OCD symptoms within 4 weeks of treatment. The relationship between OCD and HD has been little-investigated, despite the fact that both diseases are associated with striatal dysfunction and that the number of case reports of obsessive-compulsive symptoms either preceding the clinical onset of HD or during later stages of the disease is increasing. For example, Dewhurst et al. reported “obsessional features” in 7 of 102 patients at onset of HD.
ConclusionFirm conclusions to explain this result cannot be drawn. However, a hypothetical involvement of the serotonergic system, suggested by the excess of OCD, seems supported by the response of said subject to fluoxetine. It may be worth further exploring the value of the psychiatric picture in selecting the appropriate treatment for at least some cases of HD. Anecdotal evidence suggest that SSRIs alone or in combination with atypical antipsychotics like olanzapine may be useful for these patients. However, these hypotheses need further testing.
Prevalence of Psychiatric Disorders in Adolescents With Epilepsy Attending a Tertiary Care Centre in South India
- Geethu Parvathy Omanakuttan, Mithun Pulichumakal Devasia, Laura Jayne Williams, Thekkethayil Viswanathan Anil Kumar
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S55-S56
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Epilepsy is one of the most common neurological disorders characterized by an enduring predisposition to generate seizures, which can affect all age groups. Prevalence of overall psychiatric disorders among persons with epilepsy is significantly higher, and children and adolescents with epilepsy were found to have even higher rate of disorders ranging from 35% to 50%. Along with anxiety and depressive disorders, attention deficit hyperactivity disorder (ADHD) is also a common psychiatric disorder in children and adolescents. This study was primarily aimed to estimate the prevalence of psychiatric disorders among adolescents diagnosed with epilepsy. It also looked for any association between such disorders with various sociodemographic and epilepsy related factors.
MethodsA cross sectional study was conducted among 117 adolescents aged 11 to 18 years diagnosed with epilepsy. Patients with intellectual disability were excluded. After taking written informed consent and assent from parents and participants, relevant sociodemographic and clinical data were recorded. Prediction of having a psychiatric disorder was made using multi-informant type of Strength and Difficulties Questionnaire (SDQ), with a total score in borderline range suggestive of possible and score in abnormal range suggestive of probable psychiatric disorder. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 22. Chi-square test was used to find association between categorical variables. For all statistical interpretations, p < 0.05 was considered the threshold for statistical significance
ResultsAssessment with multi-informant type of SDQ has predicted that 64.1% of adolescents with epilepsy has possible (23.9%) or probable (40.2%) psychiatric disorder.
Prevalence of abnormal scores for hyperactivity subscale was 29.9%, conduct subscale was 29.1%, emotional symptoms subscale was 40.2% and peer-problem subscale was 27.4%.
88 % had high pro-social score suggestive of good social behaviors.
An abnormal or borderline total difficulty score on SDQ was significantly associated with inadequate seizure control (p = 0.029). No significant association was noted between a higher total difficulty score on SDQ with age, sex, sociodemographic status or disease related variables like age of onset, duration and type of epilepsy, monotherapy or polytherapy or family history of psychiatric illness.
ConclusionA higher proportion of adolescents with epilepsy were identified to risk of having a psychiatric morbidity, which can possibly impair the quality of life and treatment outcome, particularly in Indian context.
Early identification of such disorders using screening tools and a multidisciplinary approach for managing them at the earliest can possibly improve the outcome, for which further research is recommended.