Please give a second opinion on the diagnosis of OCD.

Question

Hi doctor,

My son is 20 years old. He is tired, fatigued and unmotivated for two years. Since from the childhood he has been troublesome and different from his siblings, but he was friendly and loving at that time. He had the habit of bedwetting till the age of 7 to 8. It seems that he has ADHD as I go through the symptoms on the internet. But, a psychiatrist said that he has OCD. My son has been disinterested, sleepy, unmotivated, tired, moody, frequently emotional and angry. He quit the college and lost two jobs due to inefficiency. He loses interest very quickly and generally lacks enthusiasm. He would like to sleep and watch movies all day. He goes out to play some days and does not seem to have any close friends. We have been trying to get him to see a doctor for over a year. Finally, he came to us and said that he knew he has ADHD. He read some stuff online. I took him to a psychiatrist the same day and doctor saw him for privately for 10 minutes and said it as OCD. He prescribed Solotik 50 mg and Xanax. Also doctor prescribed vitamin D tablets. He is not a dwarf, but of shorter stature compared to me and his brother. Also for this, he had thyroid test when he was very young, but when he agitated about this we left him. Should he continue the same medicine? Please suggest me.

Answer 1

Hello,

Welcome to icliniq.com.

Please describe his symptoms in more detail to help in making diagnosis of OCD (obsessive compulsive disorder). The symptoms you mention like lack of interest in anything, poor motivation, sleepiness, tiredness, mood swings, losing interest quickly suggest any depressive disorder or these could be due to attention deficit disorder (ADD). In general, patients with ADD have high energy and they tend to be impulsive. Tiredness, lack of motivation, etc., are not the common features. Symptoms like frequent shift of attention, hyperactivity, etc., are seen commonly. If he has the conviction that he has adult ADD and is not accepting other diagnosis, then that could be due to a fixed belief about illness which is related to obsessive compulsive spectrum. Sertraline is a safe medicine. The drug will help in controlling the depressive symptoms too, and can be given.

Answer 2

Hello,

Welcome back to icliniq.com.

The symptoms you have mentioned does not put him into a diagnosis of OCD. He was not willing to visit a doctor and that is also contrary to obsessive compulsive thoughts related to OCD. These symptoms could be occurring due to mild to moderate depression and if that is ruled out, then ADD too is a possibility. Online screening tools available are not very reliable and consult some other doctor for a re-opinion. This would prevent any risk of misdiagnosis. You can start Sertraline and no need to worry for that drug. The drug is safe to use and is free of any serious side effects. The other drug Xanax (Alprazolam) is having high abuse potential and should be used with caution. The drug might increase his symptoms like tiredness, fatigue, poor motivation, etc. So, best is to consult one more psychiatrist again. Based upon the symptoms you have mentioned it is not OCD. Thank you.