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My brother is on OCD treatment for 15 years without improvement. What is your opinion?

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My brother is on OCD treatment for 15 years without improvement. What is your opinion?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ashok Kumar

Medically reviewed by

iCliniq medical review team

Published At January 23, 2017
Reviewed AtJanuary 29, 2024

Patient's Query

Hi doctor,

My brother, who is 32 years old, is undergoing treatment for obsessive compulsive disorder (OCD) for the last 15 years without much improvement. In fact, his condition has only worsened since the start of the treatment. For the last several days, he has been complaining of erectile dysfunction, urinary hesitancy, drooping of the lip to one side during smiling, occasional numbness in extremities, etc. He has significant loss of memory (only short term) and behavioral problems. He asked me if he should be further investigated to rule out organic disease if any. So, I advised him am magnetic resonance imaging (MRI) (myself an MBBS doctor). MRI showed multiple hyperintense lesions in bilateral frontal lobes, parietal lobes and these changes were attributed to chronic ischemia by the radiologist. Now, I am concerned if his condition is merely a psychiatric disorder or a result of some organic disease. He was never investigated earlier, and all this time he was put on selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines for OCD. Kindly do help me regarding the same and guide me for the next step in his workup. His current medicines are tablet Fludac twice daily and tablet Clonafit 0.5 mg thrice daily.

Answered by Dr. Ashok Kumar

Hi,

Welcome to icliniq.com. First of all what you mentioned over in the magnetic resonance imaging (MRI) report could be coincidental finding, and there is less to do with these changes if OCD (obsessive-compulsive disorder) is considered provided there is no family history of obsessive compulsive disorder (OCD) or related psychiatric disorder. Now regarding the changes before searching anything, there is a definite need to see the reason behind the chronic ischemic changes. Although the most common causes are diabetes and high blood pressure, consistent hypotension (low blood pressure) can be another reason for ischemic changes. I like to comment on the treatment and diagnosis. If he has not responded there is definite need to review the diagnosis. On today's date, OCD is a psychiatric disorder which have best suited evidence base treatment options and it is almost rare to see a person not responding to treatment if treated properly. As I can see he is receiving two capsules of Fludac (Fluoxetine) and nothing else in regard to OCD symptoms, it can be said that the treatment was either not prescribed or not tolerated.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ashok Kumar
Dr. Ashok Kumar

Geriatrics

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