Materials and Methods: Necessary clearance from hospital ethical committee and informed consent was taken.
Diagnosis of Wilson's disease was made and patient improved on penicillamine, zinc sulfate, and lorazepam. Slit lamp examination was unremarkable and neuropsychiatric examination revealed a catatonic state with no obvious cardinal neurological manifestations of Wilson's disease. Biochemical investigations showed increased urinary copper, decreased serum copper, and decreased blood ceruloplasmin. Ultrasonography (USG) abdomen was normal. Magnetic resonance imaging (MRI) brain revealed multiple hyperintensities in internal capsule and basal ganglia. Patient did not respond to intravenous lorazepam trial of 3 days and 10 modified electroconvulsive therapy. Family history of suicide in an elder brother and two elder sisters having died of 7 months illness of similar presentation was there. Patient had no past history of psychiatric illness. S, a 20-year-old, young unmarried Muslim female presented with acute onset 5 month history suggestive of catatonia (mutism, stupor, ambitnedency, waxy flexibility, and rigidity). Patient after 8 months of follow-up is maintaining well.Ĭase Report: Ms. After 2 months of intensive behavior therapy and pharmacotherapy patient improved and Y-BOCS score reduced to 14. Patient was admitted and started on combination of clomipramine, olanzapine, and buspirone and was started on systematic desensitization addressing initially her life-threatening behavior of breath holding. Patient in past has not responded to adequate trial of several pharmacological agents namely sertraline, fluoxetine, fluvoxamine, clomipramine, and risperidon tried on outpatient department (OPD) basis. Patient was not ready for coming to the hospital due to obsession of contamination. Patient's clinical condition has deteriorated so much till presentation to us that due to fear of contamination from environmental air, patient used to stop taking breath and used to turn cyanose three to four times a day. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 30.
Mental status examination confirmed the same. Patient had no past or family history of psychiatric illness and presented with insidious onset continuous illness of 8 years duration characterized by obsession of contamination, obsessive doubts, compulsive cleaning, and repetitive ritualistic acts. Case Report: Miss S, 28-year-old, Muslim, unmarried female presented to psychiatric unit of a tertiary care hospital, Institute of Human Behaviour and Allied Sciences.
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