Tuesday, May 23, 2017

Psychiatry Case Presentation Abstract

Diagnostician’s Dilemma: Convulsing from OCD to CPS!

Presenter: Ms. Jayashree S Rao, 4th year MBBS

Treating Team: Dr. K S Shubrata, Associate Professor, Dr. Narendra, Assistant Professor, Dr. Nagaraj A V, Consultant Neurologist

Mr M, a 30 year old single male, working as an employee in a government office, from an MSES, urban background, presented to us in January 2017 with an illness of 3 years duration. His illness was of insidious onset and episodic course, characterized by brief episodes of obsessive rumination lasting for less than 5 minutes, multiple times a day and decreased concentration in work because of these thoughts. He was also suffering from adjustment disorder, depressive type because of these unremitting episodes. He has taken multiple consultations with psychiatrists with failed trials of Sertraline 150mg and Fluoxetine 60mg. He has also taken five sessions of Cognitive Behaviour Therapy (Exposure Response and Prevention) but to no avail. Mental status examination revealed depressed affect and obsessive rumination of which the exact theme was not clear. Further clarification in history revealed that these episodes were actually a part of Complex Partial Seizures. Neurologist opinion was sought and the EEG revealed inferior frontal and temporal epileptiform discharges. He was started on carbamazepine with which the episodes showed complete remission.

This case stresses the importance of detailed history taking without biased mind and getting the right investigation as and when required.