Case report: Obsessive-compulsive disorder possibly secondary to dilated perivascular space in left lentiform nucleus
Zhao Zhenru and Ng Beng Yeong
National Health Group, Singapore
Singapore General Hospital, Singapore
: J Pharm Sci Emerg Drugs
Abstract
Background: Obsessive-compulsive disorder (OCD) is a common mental illness which usually starts in the second decade of life. Onset after age of 50 is relatively rare and may be more likely to have an organic aetiology. Method: To report a case presents symptoms of OCD in a previously healthy 66 year-old man, who was found to have a dilated perivascular space in the left lentiform nucleus. Finding: A 66-year-old Malay gentleman who presented with repetitive, intrusive and distressing thoughts that ‘God is evil’ and compulsions of excessively praying or talking to himself to counteract the thoughts for two months. He does not have any past psychiatric history or family history of mental illness; he has never taken any psychiatric medications before and he does not abuse alcohol or illicit drugs. He was diagnosed with OCD according to DSM-V criteria. Physical and neurological examinations were unremarkable. A brain computed tomography (CT) scan revealed a nonspecific hypodense focus in left lentiform nucleus, and the configuration suggested dilated perivascular space and chronic in nature. He was treated with fluoxetine and the medication was titrated up to 80 mg a day. He achieved a partial remission of his OCD after 3 months of treatment. But because of his religious belief, it is hard to involve him in psychological treatments as he finds it distressing even to elaborate on his obsessive thoughts. Conclusion: This report adds to a body of evidence suggesting organic brain lesions can induce obsessivecompulsive symptomatology and shares our experience in managing such a case. However, more large scale research is needed to study the pathology and treatment of brain lesion induced OCD.
Biography
Zhao Zhenru is working in Department of Psychiatry, National Health Group, Singapore. She also worked in Department of Community Psychiatry amd Department of Community Psychiatry at Institute of Mental Health, Singapore. Zhao Zhenru has published much research papers in different reputed journals.
E-mail: zhenru.zhao@mohh.com.sg
