Gosnell Hailey L, Kablinger Anita S
School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Carilion Department of Psychiatry and Behavioral Medicine, Roanoke, VA, USA.
Case Rep Psychiatry. 2020 May 27;2020:5783191. doi: 10.1155/2020/5783191. eCollection 2020.
Obsessive-compulsive disorder (OCD), a relatively common psychiatric illness, is diagnosed using DSM-V criteria. Its severity is assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Symptoms are broken down into five categories of obsessive-compulsive (O-C) manifestations: contamination/cleaning, symmetry/ordering, taboo thoughts, doubt about harm/checking, and worry about throwing away items that could prove useful or valuable/hoarding. CBT in the form of exposure response therapy (ERP) and/or SSRI/clomipramine administration is the mainstay of treatment. We present a unique OCD case in the nature of obsessions and compulsions, cachexia presentation without anorexia, and history of multiple inpatient psychiatric admissions. Our patient's obsessions focus on eating at specific times, prompting compulsive eating patterns that often result in starvation due to missing timeframes that the patient deems acceptable for eating. His resulting cachexia and eventual worsening of depression to the point of suicidality necessitated multiple inpatient stays and placement at a long-term mental health care facility.
强迫症(OCD)是一种相对常见的精神疾病,采用《精神疾病诊断与统计手册》第五版(DSM-V)标准进行诊断。其严重程度使用耶鲁-布朗强迫症量表(Y-BOCS)进行评估。症状分为五类强迫观念及强迫行为(O-C)表现:污染/清洁、对称/整理、禁忌思维、对伤害的怀疑/检查以及担心扔掉可能有用或有价值的物品/囤积。以暴露反应疗法(ERP)形式的认知行为疗法(CBT)和/或给予选择性5-羟色胺再摄取抑制剂(SSRI)/氯米帕明是主要治疗方法。我们呈现了一个独特的强迫症病例,其强迫观念和强迫行为的性质、无厌食的恶病质表现以及多次住院精神科治疗史。我们患者的强迫观念集中在特定时间进食,引发强迫性进食模式,由于错过患者认为可接受的进食时间框架,常导致饥饿。由此产生的恶病质以及最终抑郁症恶化至自杀倾向,需要多次住院治疗并安置在长期心理健康护理机构。