Weekly Mind Reader: What Do OCD and Pica Have In Common?

This week covers OCD and self-harm, kids showing up in the ER with concurrent psychiatric conditions, and election anxiety.

Case Study Hints They Could Influence Self-Harm Behavior

A recent case study – appearing this week in The Primary Care Companion for CNS Disorders –  underscores the intricate interplay between obsessive-compulsive disorder (OCD) and pica.

A 34-year-old woman presented with severe self-harm obsessions and pica-like behavior. In addition to her anemia, she showed symptoms that included intense urges to bite hard objects, injure her eyes, and induce nosebleeds. Despite her best efforts, she typically surrendered to her urges, while craving constant encouragement from family members.

Caregivers originally administered fluoxetine, but it did little to alleviate her condition. Digging deeper, caregivers discovered she also had iron deficiency anemia, with a hemoglobin level of 8 g/dL. This prompted doctors to prescribe iron supplementation in conjunction with psychiatric treatment. Her compulsive behaviors fit the OCD profile, where patients succumb to compulsions as a result of intrusive fixations.

As treatment progressed, doctors bumped up her doses of fluoxetine, along with clomipramine and risperidone. Over the next eight weeks, her condition improved. Her Yale-Brown Obsessive-Compulsive Scale (YBOCS) score fell from 30 to 5, indicating an 80 percent reduction in symptoms. At the same time, her hemoglobin level improved to 10 g/dL.

This case underscores the often-overlooked link between OCD, pica, and iron deficiency. The woman’s self-harm obsessions and geophagia could be tied to her anemia, suggesting a need for a deeper investigation into the physiological links between nutritional deficiencies and OCD.

Treatment that pairs selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and antipsychotic medications proved effective in managing her symptoms, offering insight into potential therapeutic approaches for similar cases.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• Data analysis reveals that nearly 39 percent of kids who arrive in the emergency room show up with a concurrent psychiatric diagnosis, highlighting the importance of a holistic psychiatric care approach.
• The upcoming election is putting a strain on the mental health of many Americans, particularly younger voters and women.
• Readers write to PCC to discuss which AI modality has the most potential to help a patient with delusional parasitosis based on the Empathy Scale for Human-Computer Communication score.
• EMERGENT trials showed the newly approved xanomeline-trospium (Cobenfy) offers benefits and fewer side effects than older schizophrenia drugs.
• Finally, read the latest in our ongoing series covering PTSD and trauma research.