Multiple Psychiatric Manifestations in an Iraqi Patient with Facet Joint Osteoarthritis: A Case Report

Abstract

Introduction: Generalized anxiety disorder (GAD) is a common psychiatric condition, which is more common in females. The associated individual-societal burden of GAD is substantial. GAD can be further complicated by panic disorder (PD), a disabling condition, which is often accompanied by other psychiatric and medical conditions, including GAD. In this case, PD was accompanied by facet joint osteoarthritis (FJOA) of the lumbar spine. FJOA is a functional failure of synovial facet joints due to variable degrees of loss of the synovial cartilage. This case report aimed to present a unique interaction of psychiatric manifestations and a physical disability, both of which interacted and augmented each other substantially. Case Presentation: This was a challenging case of a young 32-year old male patient from Baghdad,Iraq. His psychiatric medical condition lasted for about three years (2012 - 2015). Almost all the patient’s problems originated from an imbalanced relationship with an older female colleague. This relationship was the source of psychological disturbance that gradually affected the patient’s routine life, work and professionalism, social interactions, and family relationships. The patient’s psychological distress was centered around the female’s past sexual life, including her past marital life, and her pre-marital experience with multiple sexual partners. The patient became gradually convinced that the female was in desperate need of his persistent support to overcome her recent divorce, which eventually exhausted the patient. Later, he developed a parallel medical condition, facet joints’ degeneration of the lumbar spine. His psychiatric condition manifested as signs and symptoms of generalized anxiety, relapsing depression, and frequent panic attacks. Conclusions: This unique case of persistent lumbar back pain became a two-faceted agent, interfering with patient’s daily physically activity, causing significant emotional distress, depression, anxiety, and frequent panic attacks. His lumbar spine problem persisted for approximately a year, but it was improved dramatically in late 2015; since then no residual effects interfered with his psychological improvement, apart from the sporadic and negligible flashbacks of his emotionally traumatic experience. In this peculiar case, the physical illness of the patient played a key role in augmenting, impending, and delaying the full psychological recovery.