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Case Studies

OBSESSIVE COMPULSIVE SPECTRUM DISORDERS

CASE STUDY: GAIL (OCD)

CASE STUDY: GAIL (OCD)

On the outside, Gail seemed like a very normal person. She went to work every day, was married to her high school sweetheart and had two small children. On the inside, however, Gail felt like a mess; she was distant from her family. She cleaned her house for hours every night after work and screamed at her husband and children when anything was out of place. She would become especially hysterical if she saw a piece of hair on the floor. She was often at the sink washing her hands and made her husband and children wash their hands more than ten times a day. The children were often withdrawn and upset and her husband was ready to leave her.

On the verge of divorce, Gail and her husband came to Amen Clinics. At first, her husband was very skeptical about the biological nature of her illness. Gail’s brain SPECT study showed marked increased activity in the anterior cingulate gyrus — a hallmark for the biological process underlying obsessive compulsive behavior and difficulty shifting attention. Within six weeks of treatment to calm this part of her brain, she became more relaxed, her ritualistic behavior diminished and her marriage got back on track.

CASE STUDY: ROAD RAGE

CASE STUDY: ROAD RAGE

A 37-year-old male attorney chased other drivers who cut him off, and on two occasions, he got out of his car and bashed in their windows with the baseball bat he kept in his car. After the second incident, he came to see us. He said, “If I don’t get help for this I’m sure I’ll end up in jail.” His SPECT scan revealed two abnormal findings:

  • Marked increased activity in the anterior cingulate gyrus causing him to get locked into the negative thoughts.
  • Left temporal lobe hyperactivity which correlated with his irritability and inability to control his frustration.

CASE STUDY: PATHOLOGICAL GAMBLING

CASE STUDY: PATHOLOGICAL GAMBLING

Adam came to Amen Clinics when his wife left him. His gambling had gotten out of control. During the past few years, he had been neglecting his business, spent more time at the racetrack, and was driving back and forth to the casinos in Reno and Lake Tahoe. “I feel compelled to gamble. I know it’s ruining my life, but it seems I have to place a bet or the tension just builds and builds.”

Adam’s SPECT study showed heavy anterior cingulate gyrus activity. Explaining the cingulate system to Adam was helpful. He could identify many people in his family who had problems with shifting attention. “You should see our family gatherings,” he said, “someone is always mad at someone else. People in my family can hold grudges for years and years.”

With a little medication, Gamblers Anonymous, and some psychotherapy to help him, he could shift away from the obsessive thoughts about gambling. Eventually, Adam could reconnect with his wife and rebuild his business.

CASE STUDY: CHRONIC PAIN

CASE STUDY: CHRONIC PAIN

Stewart, a 40-year-old roofer, hurt his back ten years ago when he fell off a roof. He underwent six back operations but remained in constant pain. He was essentially bedridden and all he could think about was his pain. He was about to lose his family, so he came in for an evaluation.

His SPECT studies revealed marked overactivity in the anterior cingulate gyrus — a finding reported in several cases of intractable pain. After five weeks on an anti-obsessive medication, he reported that although his back still hurt, but he was much less focused on the pain. He could get out of bed and function again.

CASE STUDY: ANGER/SEVERE OPPOSITIONAL DEFIANT DISORDER (ODD)

CASE STUDY: ANGER/SEVERE OPPOSITIONAL DEFIANT DISORDER (ODD)

Mark, a 14-year-old male, was evaluated for anger outbursts and constant defiant behavior. Psychotherapy and parent training were ineffective. Depakote, Ritalin, Dexedrine and Wellbutrin were also ineffective. Prozax made him much more aggressive. A SPECT study revealed marked hyperfrontality and he was placed on Risperdal. He had a dramatic response. He was more compliant, happier and less aggressive. Two follow-up studies were performed 1 month and 6 months later, which revealed progressive calming of the hyperfrontality.

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