The world has been ravaged by the coronavirus pandemic and apart from its impact on physical health of humans ,the mental health is also being affected adversely. One such disease which coronavirus pandemic was anticipated to show its effects on is the Obsessive Compulsive Disorder, as exacerbation of OCD symptoms has been
reported following previous epidemic disease out-
breaks such as SARS, MERS and influenza. There
have been anecdotal reports of increasing numbers
of patients presenting with relapse of OCD symptoms
in the midst of these epidemics.[1][2][3]
as exacerbations of OCD symptoms have been reported in other epidemics too like SARS , MERS etc.
It is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.[4]
A set of people suffering from this disorder have an obsession that they might get contaminated and to overcome this they indulge in the compulsion to clean for eg hand washing
The general fear of getting infected and the importance given to personal hygiene, may have a negative impact on this clinical population [5] It is adding to the anxiety of the people with OCD.
We present the case of a man who had well controlled symptoms of OCD and presented to us with an acute exacerbation of the symptoms during the coronavirus pandemic.
CASE REPORT
The patient is a 22 year old male, resident of Bilaspur ,Himachal Pradesh, India. He lives in a nuclear family.
He is a known case of OCD and was first diagnosed on 17 august 2018 when he presented with the obsession of seeing images of Gods and Goddesses naked. He used to feel anxious about the same and did not want to abuse the Gods and Goddesses . He also developed a magical thinking that if he didn’t pray to God then his family or he will get sick and may even die so he started praying day in , day out.
He was started on Paroxetine 12.5mg OD which was increased to 25mg and Clonazepam 0.5mg HS.
After 2 months Aripiprazole was added at 5mg OD and Paroxetine was changed to Fluvoxamine dosed upto 300mg . Post this he showed improvement and in November 2019 he was completely fine and even stopped taking medications in January 2020. He remained fine till June 2020.
In June 2020 the previous symptoms resurfaced along with phobias specific to coronavirus. These phobias resulted in severe functional impairment such that he stopped going out and even used to stop his family from going out. He used to wash his hands and sanitize excessively which was time consuming . He even put himself under self isolation. He didn’t seek any medical help or get any test done despite the family insisting him to do so.
On 14 august 2020 he got a teleconsultation as per the guidelines and was started on Escitalopram 10mg BD and Clonazepam 0.25mg BD.
As on 21 august 2020 he has showed improvement. He has reduced anxiety, obsessional images and magical thoughts. His sleep has improved. However coronavirus related phobias still persist.
DISCUSSION
This case highlights the impact of coronavirus pandemic on the people suffering from OCD. How the excessive promotion for keeping our hands clean and socially distance oneself from others to protect against the disease from spreading leads to relapse of symptoms of OCD.
The case highlights how the pandemic resulted in deterioration of the previous symptoms experienced by the patient and also led to development of new symptoms specifically related to coronavirus.
ACKNOWLEDGEMENT
[1] Acute exacerbation of OCD symptoms precipitated
by media reports of COVID-19
I. French1, and J. Lyne1,2
[2] Banerjee DD (2020). The other side of COVID-19: Impact on obsessive compulsive disorder (OCD) and hoarding.
Psychiatry Research. Advance online publication.
[3] Kumar, A., & Somani, A (2020). Dealing with Corona virus
anxiety and OCD. Asian Journal of Psychiatry, 51, 102053.
Advance online publication.
[4] APA- psychiatry.org
[5] The impact of the COVID-19 pandemic on patients with OCD: Effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study
Prestia Davide,a,b,⁎ Pozza Andrea,c Olcese Martina,d Escelsior Andrea,a,b Dettore Davide,e and Amore Marioa,b