Abstract- Poster

Abstract

Background:The onset of asymptomatic or symptomatic MS may result in specific psychiatric symptoms, as well as the long-term evolution of psychiatric disorders. Psychiatric illnesses that develop several years before MS diagnosis have been documented in the literature, although the phenomena remains poorly understood.Case description:Mrs. YB, a 32-year-old housewife, visited the LGBRIMH OPD. For the previous five years, she had a recurrent history of worry and mild physical complaints. Sleep disturbances, panic episodes, ruminative worries, muscle tension, physical weakness, and chest discomfort were among her complaints. Her mood had also deteriorated, and she was concerned that she was suffering from an incurable medical condition. There is no past psychiatric history or history of suicidal or homicidal ideation. She sought the advice of several doctors and underwent a thorough neurological evaluation and investigation, which included a physical examination and investigations such as MDCT chest and MRI-LS spine, which indicated no significant abnormalities. Following it, she was diagnosed with an anxiety disorder. Her symptoms significantly improved after she was treated appropriately. She relapsed and noted that the tingling sensation had gotten worse over 2 years. She acquired clinical signs of excessive knee jerk response on her right side of her lower limb. Repeated contrast Enhanced magnetic resonance imaging (MRI) demonstrated T2 Hyperintensities at D2 and minimal post contrast enhancement suggestive of transverse myelitis. The oligoclonal IgG immunoglobulin level in her CSF was 48.70, indicating multiple sclerosis. The patient had methylprednisolone and azathioprine treatment, which significantly relieved her symptoms.Discussion:Even if all previous tests have been done, unusual psychiatric symptoms necessitate a full neurological examination at each subsequent visit. Long-term monitoring will aid in appropriate diagnosis and provide better care for patients, resulting in a higher quality of life. INTRODUCTION: Obsessions: unwanted intrusive thoughts, lead to significant distress.Compulsions: repetitive behaviours or mental acts to neutralize obsessions.Prevalence:2to3% Onset usually in second or third decade of life.15% after the age of 35. Onset after age 50 is rare & more likely to have an organic aetiology (frontal lobes, basal ganglia).[4]Thyroid diseases may be associated with OCD (1.4 times). Studies show dysregulation of the hypothalamic-pituitary-thyroid axis in OCD.Papillary thyroid carcinoma has subthreshold OCD. [6.7.8] CASE REPORT: 54-yr/F with OCD symptoms for 4 months.OBSESSIONS: being contaminated by dirt & something terrible would happen to her family, if she sees lizard or dogs & didn't take bath.COMPULSIONS: counting till 5, bathing >10 times/day (>30 minutes), washing vessels 5 times.Avoids going out of home, taking bath for past 2 months.Sleeplessness, anxiety,worry about her illness, depressive mood.MEDICAL H/O: thyroid surgery 10 years ago. On T.THYROXINE 300mcg,raised TFT 4 months back,Now on T. THYROXINE 50 mcgNo other significant h/o.Y-BOCS:34.MRI BRAINHyperintensities B/L subcortical white matter Small ischemic changes predominant in frontal lobeTFTT3-125ng/dL T4-22.35Ug/dL TSH<0.05MIU/mLOTHERSWNL MANAGEMENT: SSRI +TCA + Psychotherapy +Thyroxine DISCUSSION: secondary OCD: accompany or follow systemic/neurologic illness.functional neuroimaging studies highlighted differences in regional blood flow.Patients with Thyroid abnormalities also develop OCD.So, always rule out organicity in late onset OCD.