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dutchie1

male 16 obsessed with food and cleanliness. assess

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16 year old male is obsessed with food and cleanliness of recent onset.

he also plays the piano a lot and wipes the keys down afterwards.

assess and manage./

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take info from gp regarding past history? family history

is he know to psychiatry services?

D/D:

OCD

PDD--autism, aspergers

Organic--tumour,

Drugs

emotional problems at home? sepration anxiety

adjustment reaction ( recently left school)

psychotic illness--schizophrenia, delusional disorder

Personality issues---comorbid or main --anankastic personality

keeeping the above in mind

take a detailed history

onset duration progress any triggers

look for OCD features---

MSE and physical

collateral from girl friend family school/work place

investigations if appopriate

manage

if ocd.

bio...ssri, clomipramine

psycho---response prevention

social- rehab?

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good

think you might have to exclude other anxiety disorders as well

autism unlikely but aspergers

possible.

would be inportant to explore the thoughts of food

and cleanliness

intrusive/

does he resist?

see as senseless?

own thought?

whats his weight/.

another differential could be eating disorder?

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In my differentials, I would consider a depressive episode as obsessive compulsive features could be secondary to it. Depression could also co-exist with OCD.

Do we need to include Tourette's as a differential?

In the m/g, don't forget to involve his family. This is coz he is only 16 plus people with ocd invariably involves their family in their ritualistic behaviours.

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yes tourettes would be a differential

also prodromal schz

as his intrusive thoughts might be coming from elsewhere and he may not regard them as senseless etc and he might be spending all day in the loft who knows..

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hi,I understand the thought stopping for obsessional thoughts is not ethical( like rubber band) what psychological treatment can we use then?

Thank u

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DD should includ LD and eating disorder I think ::)

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