A Patient with chronic Psychiatric Disorders
Anterior capsulotomy surgery for intractable OCD
Rodney King, a 51 years old gentleman, travelled from Australia to get his OCD and Depression treated @ Jaslok Hospital (JH), by Dr. Paresh K. Doshi Though Rod had started experiencing minor symptoms of OCD right from his teen age, his brother’s death in a car accident when he was 13 years old triggered the disease. He experienced intrusive images of people who were close to him being either injured or dead. He had concerns regarding cleanliness. He had unwanted thoughts of items being contaminated by germs. He washed his hands excessively and spent large amounts of time wiping down tables, door handles, stove knobs and other every-day items. He might wash the contents of his wallet because of concern that they were contaminated. He had difficulty going out in public. He repeated his movements and retraced his steps.
If he experienced an intrusive thought whilst performing an action, he would make himself repeat the action. He exhibited checking behaviours, e.g. when driving he constantly checked in the rear vision mirror to make sure that he had not hit anyone. After throwing out rubbish, he had to re-check to make sure he had not thrown out anything valuable. When shopping, he spent large periods of time deciding what to buy, even when considering mundane items. He exhibited counting phenomena, e.g. he counted letters in people’s names or the number of windows in buildings. His excessive hand washing had resulted in him causing scars to his hands because of the methylated spirits he has used. These symptoms took up the majority of his day and interfered with his everyday life. They had interfered severely in his ability to form relationships. As the disease progressed he started becoming more depressed. During the course of his illness he had tried virtually all the possible treatments available to control his disease. All drugs used to help him little (except Chlomipramine) but they brought in intolerable side effects like gastric upset. Some of the drugs made him put on excessive weight because of which he is >150 Kg. today. He also tried around 40 ECTs (Electro-convulsive therapies), > 20 cognitive and behavioural therapy, transcranial magnetic stimulation and rTMS, with a little and transient improvement.
During this time he found out about the surgical option and went to Melbourne for getting operated. He was refused surgery and this shattered him. He bought a nail gun to perform lobotomy on himself. He also tried to commit suicide (six times) to get rid of his illness. He got married, and had one son, but the marriage did not last long enough and ended up in a bitter divorce. Presently he is unemployed and lives with his mother. He found out about the surgery being offered by Dr. Paresh K. Doshi and approached him. After due deliberation with Rod’s psychiatrist and the local multidisciplinary team, Rod was offered surgery on the 18th December. He underwent anterior capsulotomy. During the surgery itself Rod found that his anxiety decreased, he felt bright, happier and his obtrusive thoughts became insignificant. He is now back with his mother and preparing to go back to Australia.
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