Indian Journal of Psychological Medicine

CASE REPORT
Year
: 2016  |  Volume : 38  |  Issue : 1  |  Page : 67--68

Atypical presentation of childhood obsessive compulsive disorder


Satyakam Mohapatra, Neelmadhav Rath 
 Department of Psychiatry, Mental Health Institute, Shriram Chandra Bhanja Medical College, Cuttack, Odisha, India

Correspondence Address:
Satyakam Mohapatra
Department of Psychiatry, Mental Health Institute, Shrirama Chandra Bhanja Medical College, Cuttack - 753 007, Odisha
India

Abstract

Obsessive-compulsive disorder (OCD) is one of the most prevalent psychiatric disorders in children and adolescents. The phenomenology of OCD in children and adolescent is strikingly similar to that of adults. But at times, the presentation of OCD may be so atypical or unusual in children and adolescents that may lead to misdiagnosis or delay in diagnosis. We report a case of 10-year-old child who was initially misdiagnosed with schizophrenia, and treated with antipsychotic for 2 months. But once the core symptoms were recognized as obsessions and compulsions and appropriately treated in the line of OCD, the symptoms resolved significantly.



How to cite this article:
Mohapatra S, Rath N. Atypical presentation of childhood obsessive compulsive disorder.Indian J Psychol Med 2016;38:67-68


How to cite this URL:
Mohapatra S, Rath N. Atypical presentation of childhood obsessive compulsive disorder. Indian J Psychol Med [serial online] 2016 [cited 2019 Sep 18 ];38:67-68
Available from: http://www.ijpm.info/text.asp?2016/38/1/67/175124


Full Text

 Introduction



Obsessive-compulsive disorder (OCD) is one of the most prevalent psychiatric disorders (0.5% to 4.0%) affecting children and adolescents and is projected to be among the ten leading causes of global disability by the World Health Organization. [1] The phenomenology of OCD in children and adolescent is strikingly similar to that of adults. But at times, the presentation of OCD may be so atypical or unusual in children and adolesents that may lead to misdiagnosis or delay in diagnosis. We report a case of 10-year-old child who was initially misdiagnosed with schizophrenia, leading to the use of antipsychotic aripiprazole for 2 months. But once the core symptoms were recognized as obsessions and compulsions and appropriately treated in the line of OCD, the symptoms resolved significantly.

 Case Report



Master A, 10-year-old male child, with uneventful birth and developmental history without past and family history of neurological and psychiatric illness presented with complaints of repetitive spitting, withdrawn to self, lack of interest in study, repeatedly closing his ears by hands from last 8 months and refusal to take food from last 7 days. He was hospitalized. On physical examination, all parameters were within normal limits except presence of mild dehydration. Intravenous (IV) fluids were started. On initial mental status examination, the patient was unable to express the reason behind this type of behaviour. On repeated evaluation, the patient expressed that he did not want to take food as he thinks that any word spoken by him or by nearby people or any word heard by him from any source were written on his own saliva and he cannot swallow the words with food or saliva. For this reason, he was spitting repetitively, avoiding interaction with people, avoiding food. To avoid any sound, he closes his ears by hands most of the times. He expressed that this type of thought was his own thought and absurd one. He tries to avoid this thought but he was unable to do so. After 6 months of onset of his illness, he was treated by a psychiatrist as a case of schizophrenia and was prescribed tablet aripiprazole 10 mg per day. After 2 months of treatment, instead of any improvement, his condition deteriorated and he visited our department. After evaluation, a diagnosis of OCD, mixed obsessional thought and acts was made as per International Classification of Diseases-10 th Edition criteria. [2] He scored 30 in Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). [3] He was prescribed tablet fluoxetine 10 mg per day and was increased to 20 mg per day after 5 days. As the patient was not taking food by mouth, so nasogastric tube feeding was started. He improved gradually and started taking food orally. After 4 weeks, dose of fluoxetine was increased to 40 mg per day. His CY-BOCS score dropped to 19 after 8 weeks of treatment and he was discharged from the hospital.

 Discussion



OCD is a highly heterogeneous disorder, presenting with a wide range of symptoms. Especially in children and adolescents with OCD typically first try to ignore, suppress or deny obsessive thoughts and may not report the symptoms as ego-dystonic or senseless. In our patient, certain clinical features like repeated spitting, withdrawn to self and often closing his ears by hands were mistaken as features of schizophrenia. On initial evaluation, the child was unable to give any reason behind his unusual behaviour. But on repeated evaluation, obsession was identified. He has the obsession that any word heard by him from any external source is being written on his saliva and then he feels very painful to swallow the saliva. This type of obsession is very unusual. He has full insight into his symptoms. No psychotic symptom is elicited on evaluation. So if proper evaluation is done, such cases can easily be recognized and treated effectively.

References

1World Health Organization. Mental health: Facing the challenges, building solutions. In: Report from the WHO European Ministerial Conference; 2005 January 12-15, 2005. Helsinki: World Health Organization Regional Office for Europe; 2005. p. 1-82.
2World Health Organization. Mental disorders: Glossary and guide to their classification in accordance with the Tenth Revision of the International Classification of Diseases. Geneva: World Health Organization; 1992.
3Scahill L, Riddle M, McSwiggin-Hardin M. Children's Yale-Brown obsessive compulsive scale: Reliability and validity. J Am Acad Child Adolesc Psychiatry. 1997;36:844-52.