Case Study - I

OBSESSIVE COMPULSIVE DISORDER

SOCIODEMOGRAPHIC DETAILS

Name: FS

Age: 35 years

Sex: Female

Marital status: Unmarried

Religion: Muslim

Education: 10th fail

Occupation: Unemployed

Socioeconomic status: Middle class

Location of residence: Urban

Mother tongue: Malayalam

Family type: Nuclear

Informant: Mother

Source of referral: Nill

Information: Reliable & adequate

CHIEF COMPLAINTS
As per the client:

● Repeated washing of hands

● Taking bath 3 to 4 times a day
● Becomes irritable when dust or other food particles fall on her body or dress.
● Stubborn
● Repeatedly cleaning the floor
● She wants others to do things in her own way.
● Repeated thought about cleanliness

As per the informant

● She had refused many marriage proposals

● She wasn’t having a proper food for long time
● She plays with water too much

NATURE OF ILLNESS

Duration of illness: Past 10 years

Mode of onset: Acute

Course: Continuous

Progress: Static

Predisposing factors: Reason could not be elicited

Precipitating factors: Reason could not be elicited

Perpetuating factors: Reason could not be elicited

HISTORY OF PRESENTING ILLNESS

The patient is a 35 year old female. She is the second child in the family and she lives along with
her mother. The onset of the illness was acute. She repeatedly washes her hands and takes bath 3
to 4 times in a day because of the thought that it has not been cleaned properly. She is very rigid
and stubborn and wants others to do things in a way that she wants it to be done. Excessive
doubts about the cleanliness are shown by her. She becomes easily irritable when dust or some
food particles fall on her body or dress. She repeatedly cleans the floor and plates. Her parents
started to observe these symptoms when she was 25 years old. She shows her reluctance when
others try to do certain things. She spends most of her time involved in these types of cleansing
activities.

NEGATIVE HISTORY

The patient has no history of significant head injury, seizure, mental retardation or neurological
disorders.

TREATMENT HISTORY

At age of 25, she consulted a doctor in Parambra, Kasargod.

In 2022, she took treatment from Louise Mount Hospital, Wayanad.

Currently taking treatment from Louise Mount Hospital, Wayanad.

FAMILY HISTORY

Patient is from a middle class family. She lives with her mother. She is the second child of her
family and has an elder sister and a younger sister. Both sisters are married. There is no reported
history of psychiatric illness in the family. She has a good relationship with her mother and
siblings.

PERSONAL HISTORY

● Birth history: Patient was a wanted child, born full term with no reported complications.
Her birth weight was normal and the birth cry was also normal.
● Milestone development: Speech, motor, speech, cognitive and social development during
childhood reported to be normal.
● Childhood history: She had good relationships with parents, siblings and family
members. No significant childhood history was reported.
● Educational history: She was poor in studies and is 10th fail. Relationships with teachers
and peers were good.
● Occupational history: Patient has not gone for any occupation and is currently
unemployed.
● Marital History: Unmarried
● Sexual History: No specific concerns were reported.
 ● Premorbid personality: Patient from childhood was stubborn and rigid. She wanted others
to do things in a way she wanted it to be done. Showed excessive doubts. She spends too
much time trying to do things perfectly.

MENTAL STATUS EXAMINATION

Ⅰ. GENERAL APPEARANCE

● Dressing: Personal hygiene and cleanliness is maintained.

● Cooperativeness: Cooperative
● Eye contact: Maintained
● Rapport: Established
● Psychomotor activity: Patient displayed normal level of psychomotor activity.

Ⅱ. ATTENTION AND CONCENTRATION

Digit Forward

29 ✓

578 ✓

9582 ✓

25791 ✓

257931 ✓

Digit forward: 6

Digit Backward

28 ✓
256 ✓

2894 ✓

34567 ✓

Digit backward: 4

Attention and concentration are aroused and sustained.

Ⅲ. MEMORY

● Immediate memory

Q: Can you recall these words?

Pen, pencil, book, bucket

Ans: Pen, pencil, book, bucket

Immediate memory is intact.

● Recent memory

Q: What did you have for breakfast?

Ans: Upma

Recent memory is intact.

● Remote memory
 Q: Do you remember your birth place?

Ans: Kasargod

Remote memory is intact.

Ⅳ. INTELLIGENCE

● General knowledge

Q: What is the name of our prime minister?

Ans: Do not know

Poor level of general knowledge.

● Arithmetic’s

12+4 =16

10*5 = 15

7-8 = 2

Poor level of arithmetic’s

● Comprehension

Q: What is the use of a driving license?

Ans: to drive

Average level of comprehension

Ⅴ. ABSTRACT THINKING

Q: What is the difference and similarity between a bulb and a fan?

Ans: bulb gives light and fan reduce sweating and both works under electricity
Functional level of abstract thinking.

Ⅵ. ORIENTATION

Q: What is the time now?

Ans: Afternoon

Oriented towards time.

Q: Which place are you in right now?

Ans: Hospital

Oriented towards the place.

Q: Do you know who I am?

Ans: Student

Oriented towards person

Ⅶ. VOICE AND SPEECH

Speech is audible, coherent and reaction time is normal.

Ⅷ. PERCEPTUAL DISTURBANCES

No perceptual disturbances.

Ⅸ. THOUGHT DISTURBANCES

Stream of thought: Normal

Content of thought: Obsessional thoughts/urges that are recurrent / intrusive and cause distress to
the patient.

Possession of thought: normal

Form of thought: normal

Ⅹ. JUDGEMENT

Test judgment

Q: What will you do if you get a letter with the address lying on the road.

Ans: Return to that address

Test judgment is satisfactory.

Personal Judgment

Q: What is your plan after leaving this hospital?

Ans: See my mother

Poor personal judgment

Social judgment

Q: What will you do when a guest comes home?

Ans: Will welcome them and give them something to eat.

Social judgment is satisfactory.

Ⅺ. MOOD AND AFFECT

Mood: Euthymic

“I feel ok”

Affect: Anxious
INSIGHT

Partially present

DIFFERENTIAL DIAGNOSIS

● Compulsive Personality Disorder

● Generalized Anxiety Disorder

Points For : Recurrent irrational, uncontrollable thoughts. Doubt about cleanliness

and engaging in cleaning behavior without any reason.

Points against : This could be due to generalized anxiety disorder, compulsive

personality disorder.

DIAGNOSTIC FORMULATION

Patient FS is a 35-year-old, unmarried female from a middle-class family. She is the second child
in her family and has an elder sister and a younger sister. She lives with her mother. She exhibits
repeated washing of hands, floors and plates, she takes bath 3 to 4 times a day. She is very
stubborn and rigid and she wants others to do things in a way that she wants it to be done. She
becomes easily irritable when dust or other food particles fall on her dress or body. Mode of
onset was acute but she portrayed OC traits in her childhood onwards. Course of illness is
continuous and the duration of illness is for the past 10 years.

Mental status examination reveals that she is cooperative and maintains eye contact. Attention
and concentration are aroused and sustained. Immediate, recent and remote memory is found to
be intact. Average level of general knowledge and arithmetic’s. Average level of comprehension
and functional level of abstract thinking. Patient is oriented towards place, time and person.
Voice and speech are audible, coherent and reaction time is normal. Possession and form of
thought is normal.Test and social judgment are satisfactory and personal judgment is found to be
poor. The patient shows obsessional thoughts that are recurrent and cause distress in the patient.
Mood is euthymic and the patient has anxious affect. Insight is partially present.
PROVISIONAL DIAGNOSIS

F42. Obsessive Compulsive Disorder. With the complaints of;

1. Recurrent unwanted thoughts, referencing contamination, need for perfection

and abnormal doubts.

2. Repetitive acts, impulses such as excessive washing, checking, rearranging

things.

3. Impaired social or work functioning.

TREATMENT PLAN

● Exposure and response prevention therapy (ERP)

● Cognitive Behavioural Therapy(CBT)
● Relaxation Techniques
● Psychoeducation for client and family
● Counseling session for clients to maintain a balance between work life & personal life.