OCD

 

Post of interview OCD patient after DBS

 

Obsessive Compulsive Disorder (OCD)

 

Millions of people suffer in silence affected by a disorder that affects about 2% of the population. Obsessive Compulsive Disorder (OCD) patients have a tendency to keep the disorder secret, suffering for months or years because they feel too humiliated or do not wish to be considered mad. Surveys have shown that it is not that rare a condition-it is the fourth commonest psychiatric illness.

 

Typically a person with obsessions has repetitive thoughts, urges or images which cause a lot of anxiety (tension) to the individual. He recognizes these as senseless and unsuccessfully try to resist them. Compulsions are behaviours that are performed to lessen anxiety that is a result of particular obsessive thoughts.

 

The common obsessions are fear of dirt and contamination by germs; sexual and aggressive images or thoughts towards a family member; doubts of having left a task incomplete; hoarding useless things as they may have value in the future; need to have things perfectly in symmetry and order; evil and sinful thoughts and urges. Common compulsive behaviours are cleaning and washing, checking, arranging things in an orderly manner, counting or doing things in a certain number .25% all OCD patients became refractory after few years and will require DBS therapy

 

 

Mrs Khan is a 48 year old housewife and a mother of two children who has been symptomatic for the past 20 years with the fear that she will be contaminated by drain water and seeks reassurance frequently from her husband that she has not been touched by it. She has doubts that she may have touched drain water and frequently washes herself. Her husband has to open and close taps as she thinks they are contaminated and even has to pour out water for her.

 

When her husband and son go out of the house she sits immobile at home, she does not cook, eat or even go to the toilet as she fears contamination. This goes on till her husband or son return. Cooking is an elaborate ritual where she orders her son to do the various chores and makes him wash any utensils she touches.

 

The family frequently eats food from outside, She had been treated with medication and CBT and had improved but about 8-9 years earlier she stopped medication, subsequently she had recurrence of symptoms which only kept worsening despite use of SSRIs and augmenting them with various combination of medication. Seeing that nothing was working out, it was thought that a neurosurgical procedure would probably help her. She was then referred to us.

 

It was decided that the best course of management would be the FDA approved DBS (deep brain stimulation) therapy She was placed on an extensive pre-op protocol for about six months before she was finally operated on 23 Aug 2010,. Deep brain stimulation surgery was performed and the device placed in her. The device was made operational at the lowest settings about a week later and some behavioral improvements were noted while she was in the hospital.

 

She has shown significant improvement after this surgery she is eating by herself, touching things and going to toilet on her own, activities which she would have avoided earlier. At home, she does not require assistance for day to day work like cooking going to market for buying things but she is now confident that she will overcome her difficulties.


What is the role of DBS for OCD

for intractable OCD who are not responding to medication DBS is very efective symtoms are 60-70% improve and medication are slowly reduced over period of time

 

Case Study