Very briefly, we would like to introduce our case report as follows. Mrs A, a 28-year-old woman, was admitted to the Department of Psychiatry in our hospital because of recurrent depressive episodes and aggravating compulsive behaviors. Two years prior to admission, this patient developed her first depressive episode after breaking up with her ex-boyfriend. Thereafter, this patient became depressed and had insomnia, loss of appetite, and loss of interest. Meanwhile, she began to repetitively tidy up her belongings and check whether the windows and doors were closed. There was no suicidal ideation reported at that moment and she could still adhere to the work as a bank staff. However, pressure at work made her situation worse. Her obsessive behaviors gradually aggravated, with repetition rate remarkably increasing from several times per day to dozens of times per day. The obsessive behaviors always worsen when her mood became labile. This patient became easily upset and agitated when being persuaded by her family members. About half a year prior to admission, this patient reported the first suicidal attempt after fighting with her parents. She went into emotional outburst, stood at the window, and claimed to end her own life. Her parents even kneeled on the floor to take her out of committing suicide. Since then, she had reported repetitive suicidal attempts. She would rush to the balcony or windows and would attempt to commit suicide by jumping down from the building, while she was also reported with dangerous driving behaviors. Consequently, her daily life and job were seriously disrupted.
The patient was then sent to our hospital by her parents. A primary diagnosis of OCD was made, and paroxetine was prescribed at a daily dose of 40 mg. About a week later, the patient became extremely excited, talkative, and vigorous. Although paroxetine was discontinued soon afterward and quetiapine was initiated, her manic state lasted for nearly 3 weeks. Therefore, hospitalization was suggested by her doctor.
After admission, a comprehensive physical and laboratory examinations were performed to exclude unknown underlying physical diseases. Besides, cranial magnetic resonance imaging scan was also normal. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, this patient was dually diagnosed with bipolar I disorder and OCD. Quetiapine was gradually titrated up to 700 mg per day with concomitant valproate at 1,000 mg per day. Although her emotion became stable with these mood stabilizers, the patient reported an inadequate response in symptoms of OCD. A small dose of atypical antipsychotics was considered to enhance the treatment efficacy. Fascinatingly, an add-on therapy of aripiprazole 10 mg per day promoted accelerating alleviation of her obsessive behaviors. Meanwhile, no severe adverse events were observed. Her remission in emotional and OCD symptoms was well maintained in the follow-up visits. No suicidal attempt was reported after hospital discharge. A detailed rating of clinical scales is recorded in Figure 1.
This work was approved by the Institute Ethical Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, and written informed consent was obtained from the patient and her guardians.