An elderly man comes to the outpatient department with his son. His face is familiar because he keeps frequenting the hospital, every time with a complaint which grows in complexity. He was looking very worried, his son even more. He is a known case of OCD (Obsessive compulsive disorder), a disorder characteristically marked with persistent thoughts of contamination, among many other things, that are experienced as coming against one’s will. This causes lots of distress and some indulge in washing their hands all day long. This man is retiring from his job and on the day of the farewell ceremony that his company had arranged, they were presenting him a cheque of Rs.18,00,000. It was his hard-earned money. But he saw at the ceremony that the cheque was touched by many people and some of them from a lower caste. So he refuses to accept this cheque as its contaminated, apparently it had become untouchable. His family members go crazy with his behavior and bring him to hospital to somehow make him to accept this cheque and get it signed, so that they get the money. Despite weeks of medications and persuading, he still remains hell-bent on not taking that cheque. Its very hard to imagine that somebody can deny 18 lakhs due to the fear that his hands may get dirty. This just shows how difficult it can become to treat this condition…
9 comments:
hey nice case.. but dont u think something is fishy in this case.. the patient knows that his believes are not true and still is compelled by the thought to do certain acts.. but the history somehow looks doubtful of a case of OCD.. at what age did he provide his OCD.. what other OCDs he has other than fear of contamination... can't this be some other condition... good u put of something atlast
great post- unique case of ocd, a person refusing 18 lacks! for fear of getting his hands dirty...
is insight present in the patient? does he realise what he is doing is nonsensical?
ya...he knows that it is his own thoughts, but they come against his own will...he tries to resist them but he cant...this leads to lots of distress...
he is suffering from ocd from many years..and is very famous in our hospital...this was worked up by some other doctor this time...his main complaints are persistent thoughts of contamination and frequent hand washing...i dont know abt other things right now...i will tell the details if u want...and the point u have made is characteristic of ocd right, the patient knows that his thoughts dont make any sense but is still barged with those thoughts and compelled to act on them....there is no doubt abt the dx..
why dont they just transfer the amount to his account? solves his OCD and his money problem
ya...we too asked whether he can authorize someone to get it...or is there any other way...but it seems he has to sign the cheque...
but with ur patient the actions don't seem to be egodystonic... if it was, he would be rather saying that 'i want to take the check but i can't'.. so more elaborate history would have cleared a few doubts i guess
the core obsession is of contamination and that is ego-dystonic....so he is compelled not to take that cheque...that should make things clear...
wat u say is true.. but i couldnt find anything in the history that would suggest that these reactions are ego-dystonic.. the history just mentioned that he doesn't want to take the cheque.. there was no sign of conflict, so just thought of cross checking
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