Journal of Mental Health and Human Behaviour

CASE REPORT
Year
: 2020  |  Volume : 25  |  Issue : 2  |  Page : 146--148

COVID-19 as a “nightmare” for persons with obsessive-compulsive disorder: A case report from India


Swapnajeet Sahoo, Seema Bharadwaj, Aseem Mehra, Sandeep Grover 
 Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India

Abstract

The impact of coronavirus disease 2019 (COVID-19) on patients with psychiatric illnesses has also been worrisome for psychiatrists. Most of the mental health organizations have mentioned that of all the psychiatric disorders, COVID-19 could worsen the symptoms of people with preexisting obsessive-compulsive disorder (OCD). Fear of contamination with germs is one of the most common intrusive obsessive thoughts with subsequent ritualistic and compulsive handwashing in patients with OCD. The current guidelines and the only safety strategy employed for infection control is frequent hand hygiene. In this regard, there is every possibility that those with preexisting OCD can have worsening of symptomatology, or many individuals can develop new-onset obsessive-compulsive symptoms that need to be addressed and appropriately evaluated. We report an individual with OCD on treatment who relapsed following the outbreak of the COVID-19 pandemic. This case would help to raise awareness among mental health professionals to have a different approach to patients with OCD during the ongoing pandemic.



How to cite this article:
Sahoo S, Bharadwaj S, Mehra A, Grover S. COVID-19 as a “nightmare” for persons with obsessive-compulsive disorder: A case report from India.J Mental Health Hum Behav 2020;25:146-148


How to cite this URL:
Sahoo S, Bharadwaj S, Mehra A, Grover S. COVID-19 as a “nightmare” for persons with obsessive-compulsive disorder: A case report from India. J Mental Health Hum Behav [serial online] 2020 [cited 2021 Jul 31 ];25:146-148
Available from: https://www.jmhhb.org/text.asp?2020/25/2/146/309973


Full Text



 Introduction



The current outbreak of coronavirus disease 2019 (COVID-19) since December 2019 had created havoc in the health-care setups of almost all the countries and has resulted in mass deaths worldwide.[1] The rates of infection and mortality are highest in persons with comorbid physical illnesses and in the elderly.[1] However, its impact on patients with psychiatric illnesses has also been worrisome for psychiatrists. Most of the mental health organizations have mentioned that of all the psychiatric disorders. COVID-19 could worsen the symptoms of people with preexisting obsessive-compulsive disorder (OCD).

Fear of contamination with germs is one of the most common intrusive obsessive thoughts with subsequent ritualistic and compulsive handwashing in patients with OCD. The basic safety precaution, which is being advocated as a means to control infection, is proper and frequent handwashing. The educational information in all forms is propagating that COVID-19 infection spreads by touching fomites (door handles, toilet taps, any inanimate objects, etc.) of suspected/COVID-19 individuals. It is predicted that such an act could lead to worsening to the usual preexisting patterns of ritualistic and compulsive handwashing in individuals with OCD. Further, the doubts of being contaminated with germs of COVID-19 could very well increase because of it being highlighted again and again in most of the news/social media platforms/websites related to COVID-19. While all these instructions are very understood from preventive health perspectives to tackle COVID-19 infection, yet these can lead to a relapse of previously controlled symptoms in patients with OCD. Various websites' posts/blogs have mentioned the COVID-19 pandemic to be the worst nightmare or a “hell-” like experience for those with OCD.[2]

More recently, the International College of Obsessive-Compulsive (OC) Spectrum Disorders and the Obsessive–Compulsive and Related Disorders Research Network of the European College of Neuropsychopharmacology had drafted management perspectives for patients with OCD for practitioners related to telemedicine approach, risk assessment for suicide, worsening of the condition, providing psychoeducation with balanced information about COVID-19 to patients and caregivers, etc.[3] All these further demonstrate the importance of managing patients with OCD during the ongoing pandemic, which is expected to stay for months all over the world.

In this report, we present an individual with OCD on treatment who relapsed following the outbreak of the COVID-19 pandemic.

 Case Report



A 28-year-old male was diagnosed with OCD 5 years before the presentation and was maintaining well on capsule fluoxetine 60 mg/day. Previously, he had obsessive doubts of contamination with compulsive handwashing rituals and repeated checking behavior (door latches, knobs, taps, etc.) from which he had significantly improved. However, after the outbreak of the COVID-19 pandemic, and subsequent to listening (television) and reading (social media platforms and newspapers) about all the hand hygiene measures, route of infection, and potential sources of COVID-19 infection, gradually, he began to remain more and more anxious. Within a few days, his anxiety increased markedly, and all his OC symptoms in the form of washing hands and checking things increased. Due to increase in symptoms, he was not able to function at his workplace because it involved touching things and handing over papers to colleagues and receiving the same. Within 1 week of relapse of symptoms, he was completely dysfunctional at home and at workplace and he stopped going to his work. At home, he started to engage in frequent washing of hands and would spend around 7–8 h in cleaning, face washing, and bathing to overcome repeated intrusive thoughts/doubts about contacting infection. He would not allow anyone to come near him because of fear of getting infected. Gradually, he started to remain sad and developed syndromal depression, amounting to moderate depression without somatic symptoms. Due to marked psychosocial dysfunction, he was brought to the emergency services, where he was counseled, and the dosage of capsule fluoxetine was increased to 80 mg/day. He was also psychoeducated about how to control his excessive washing behavior, without risking the spread of infection. Further, he was taught relaxation exercises, and supportive psychotherapy sessions were started telephonically. This led to a significant decrease in his anxiety symptoms.

 Discussion



As evident from the case description, the COVID-19 infection precipitated a relapse in a well-controlled person with OCD on medications. Therefore, it is of utmost importance to address the issues pertaining to the relapse of OC symptoms in patients with OCD during this COVID-19 outbreak. Some of the mental health organizations, including the International OCD Foundation, had laid down some basic tips for managing anxiety and OC symptoms during the COVID-19 pandemic.[4] Some of the useful tips are controlling exposure to news; following recommended advice in a controlled fashion (i.e., learn to resist the compulsion to wash hands and clean every surface one has touched); staying connected with family, friends, and near ones (i.e., practice social distancing not emotional distancing); setting a routine to be self-occupied; and trying to be compassionate to oneself.[5]

Few points to distinguish between OC-related contamination doubts and subsequent handwashing rituals vis-à-vis' doing hand hygiene and other infection control measures in relation to health guidelines are (1) to identify the degree of preoccupation with contamination or time spent in performing handwashing/cleaning rituals, (2) to explore for the thoughts related to ritualistic washing behaviors, that is, to establish if there is any connection between COVID-19-related infection control measures and current washing and avoidance behaviors, and lastly (3) to explore for insight of the person, that is, how much concerned the individual is regarding his/her changed behavior or if the individual is able to identify that he/she is doing washing rituals or practicing avoidance behavior in excess.

While the anxiety leading to OC symptoms in patients with OCD may not be inevitable, these tips/advice can help cope with OCD's stress related to OCD during the COVID-19 crisis. Further, the fear of getting COVID-19 infection among the general public is an invisible threat that cannot be avoided. Therefore, fears and anxiety of patients with OCD must be addressed and in the wake of the absence of regular outpatient services, they must be managed with the help of the technology/telemedicine/telepsychiatry consultations. Mental health professionals might have to remain prepared to see symptom exacerbations in previously diagnosed patients with OCD as well as new-onset OC symptoms in routine consultations during the ongoing pandemic. They might have to develop their own skills to do different types of cognitive-behavioral therapies in patients with OCD.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Coronavirus, n.d. URL. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Last accessed on 2020 Apr 07].
2A Pandemic is Hell for Everyone, But Especially for those With OCD HuffPost India Wellness, n.d. URL. Available from: https://www.huffingtonpost.in/entry/coronavirus-pandemic-ocd-anxiety_l_5e84b7f4c5b65dd0c5d7ea7e. [Last accessed on 2020 Aug 04].
3Fineberg NA, Van Ameringen M, Drummond L, Hollander E, Stein DJ, Geller D, et al. How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician's guide from the International college of obsessive compulsive spectrum disorders (ICOCS) and the obsessive-compulsive and related disorders research network (OCRN) of the European College of Neuropsychopharmacology. Compr Psychiatry 2020;100:152174.
4International OCD Foundation Coronavirus (COVID-19): Resources for the OCD and Related Disorders Community, n.d. International OCD Foundation. URL. Available from: https://iocdf.org/covid19/. [Last accessed on 2020
5Tips for Coping with OCD during the Coronavirus Pandemic, n.d. Young Minds. URL. Available from: https://youngminds.org.uk/blog/tips-for-coping-with-ocd-during-the-coronavirus-pandemic/. [Last accessed on 2020 Aug 04].