CASE REPORT: DIFFERENTIAL DIAGNOSIS OF OBSESSIVE-COMPULSIVE SYMPTOMS CONFOUNDED BY DELUSION-LIKE FIXATIONS AND SOMATIC SYMPTOMS IN AN ADOLESCENT

Yıl 2017, Cilt: 18 Sayı: 4, 157 - 161, 16.10.2017

Serhat Nasıroğlu , Veysi Çeri

https://doi.org/10.18229/kocatepetip.368698

Öz

Obsessive-compulsive symptoms can at times be
confounded by delusional symptoms, which can
be especially challenging to interpret correctly in
children and adolescents, who may struggle to articulate
the intrusive or unreasonable nature of their
obsessions. Obsessions, overvalued ideas and delusions
can have an overlap. Persistent headaches are
not uncommon amongst patients presenting with
anxiety disorders and psychosomatic symptoms
are frequently reported by children. Psychosomatic
complaints, such as enduring headaches, can also
have an undesirable impact on therapeutic approach
and delay access to the correct treatment. In this
case we discuss diagnostic pitfalls in an adolescent
girl presenting with obsessive-compulsive symptomatology
and a successful treatment of enduring
symptoms with psycho-education and medication.
We will argue that psycho-education for young people
and their families based on a correct diagnosis
of obsessive compulsive disorder (OCD) is essential
to provide reassurance, to help young people regain
self-confidence and re-establish constructive
relationships within the family unit. Selective serotonin
re-uptake inhibitors (SSRI) are the drug of
choice for pharmacological treatment of OCD in this
age group. We conclude that a correct diagnosis of
the condition as "anxiety-driven" was of paramount
importance for psychological approach and pharmacological
management of this case. 

Anahtar Kelimeler

Adolescent, Obsessive Compulsive Di-sorder, Selective Serotonin Re-uptake Inhibitor, Ob-session, Delusion

SANRI BENZERİ SAPLANTILAR İLE SOMATİK SEMPTOMLARIN EŞLİK ETTİĞİ OBSESİF KOMPULSİF SEMPTOMLARIN AYIRICI TANISI, BİR OLGU SUNUMU

Öz

Obsesif Kompulsif Semptomlar, özellikle de zorlayıcı
nedensiz obsesyonlarını açıklamada güçlük çeken
çocuk ve ergenlerde olmak üzere sanrılar ile karışabilmektedir.
Obsesyonlar, aşırı zihinsel uğraşlar ve
sanrılar ile karışabilmektedir. Psikosomatik semptomlar
çocuklar tarafından sıklıkla belirtilen bir durumdur
ve sürekli baş ağrıları anksiyete bozukluğu
olan kişilerde nadir değildir. Sürekli baş ağrıları terapotik
yaklaşımı olumsuz olarak etkileyebilmektedir
ve aynı zamanda doğru tedaviye de ulaşmayı güç-
leştirmektedir. Bu olguda obsesif kompulsif semptoloji
ile başvuran bir kız ergendeki tanısal güçlükleri
ile bu semptomların psikoeğitim ve farmakoterapi
ile başarılı bir şekilde tedavisi tartışılmaktadır. Aynı
zamanda obsesif kompulsif bozukluğun (OCD) doğ-
ru tanısı ile ergenler ile ailelerine psikoeğitim verilmesinin
bu gençlerin öz güvenlerine kavuşmaları ve
aileleri ile tekrar yapılandırılmış bir ilişki kurmaları
için önemi tartışılacaktır. Bu yaş bireylerde OKB’nin
farmakolojik tedavisinde seçilecek ajan Selektif Serotonin
Geri Alım İnhibitöreleridir (SSRI). Son olarak
bu olgunun anksiyete ile ilişkili bir durum olarak
doğru şekilde tanımlanması ve psikolojik yaklaşımı
ile farmakolojik yönetimi oldukça önemlidir

Anahtar Kelimeler

Genç, Obsesif Kompulsif Bozukluğu, Selektif Serotonin Geri Alım İnhibitörü, Takıntı, Kuruntu

Kaynakça

• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth ed. rev. Washington DC, American Psychiatric Association, 2000.
• Rasmussen SA, Eisen JL. Epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry. 1990;53:10– 14.
• Piacentini J, Bergman RL, Keller M, McCracken J. Functional impairment in children and adolescents with obsessivecompulsive disorder. Journal of Child and Adolescent Psychopharmacology. 2003;13:61–69.
• Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry. 2010;15:53–63.
• Zohar AH. The epidemiology of obsessive-compulsive disorder in children and adolescents. Child AdolescPsychiatrClin N Am. 1999;8:445-460.
• Thomsen PH. Obsessivecompulsive disorder: Pharmacological treatment. Eur Child Adolsc Psychiatry 2000;9 Suppl 1:/I/7684.
• The Pediatric OCD Treatment Team. Cognitivebehaviour therapy, sertraline, and their combination for children and adolescents with obsessivecompulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA. 2004;292:1969-76.
• March JS, Frances A, Carpenter D, Kahn DA. The expert consensus guidelines series: Treatment of obsessivecompulsive disorder. J Clin Psychiatry. 1997;58:172.
• Aardema F, O’Connor KP, Emmelkamp PM, Marchand A, Todorov C. Behavinferencial confusion in obsessive-compulsive disorder: the inferencial confusion questionnaire. Res Ther. 2005;43(3):293-308.
• Kitis A, Akdede BB, Alptekin K, Akvardar Y, Arkar H, Erol A, et al. Cognitive dysfunctions in patients with obsessive-compulsive disorder compared to the patients with schizophrenia patients: relation to overvalued ideas. ProgNeuropsychopharmacolBiol Psychiatry. 2007;31(1):254-61.
• Rapaport JL, Inoff G. Practitioner review: Treatment of obsessive-compulsive disorder in children and adolescents. J. Child PsycholPsychiat. 2000;41:419-431.
• Singer, H. S. (2015). PANDAS: The need to use definitive diagnostic criteria.Tremor and Other Hyperkinetic Movements 2015;5:327.
• O’Dwyer AM, Marks I. Obsessive-compulsive disorder and delusions revisited. Br J Psychiatry. 2000;176:281-4.
• Ercan E. S, Ardic UA, Ercan E, Yuce D, Durak S. A Promising Preliminary Study of Aripiprazole for Treatment-Resistant Childhood Obsessive-Compulsive Disorder. Journal of child and adolescent psychopharmacology. 2015;25(7):580-584.
• McKenna PJ. Disorders with overvalued ideas. British Journal of Psychiatry. 1984;145:579 -585.
• Hudson JI, Mangweth B, Pope HG Jr, Hausmann A, De Col C, Laird NM, Beibl W, Tsuang MT. Family study of affective spectrum disorder. Arch Gen Psychiatry 2003;60:170-177
• Dinn WM, Aycicegi-Dinn A, Robbins NC, Harris CL. Migraine Headache and Obsessive-Compulsive Symptoms in a Student Sample. Bulletin of Clinical Psychopharmacology. 2005; 15:174- 181
• Scarella TM, Laferton JA, Ahern DK, Fallon BA, Barsky A. The Relationship of Hypochondriasis to Anxiety, Depressive, and Somatoform Disorders. Psychosomatics. 2016;57(2):200-207. 19. Hocaoğlu Ç. Farklı Bir Hipokondriyazis: Bir Vaka Sunumu. Journal of Mood Disorders. 2015;5(1):36-9.