Improvement in Obsessive-Compulsive Disorder Following Right Anterior Temporal Lobectomy and Amygdalohippocampectomy in a Patient with Refractory Temporal Lobe Epilepsy with Right Mesial Temporal Sclerosis.

There are reports of co-occurrence of obsessive-compulsive disorder (OCD) in patients with temporal lobe epilepsy (TLE). We present a report of a patient with refractory TLE due to hippocampal sclerosis with concomitant OCD on pharmacotherapy for both. She underwent surgery for standard anterior temporal lobectomy with amygdalohippocampectomy and reported improvement in obsessive-compulsive symptoms subsequently. We seek to further evidence of interaction between the two conditions and argue to undertake future research exploration on the same.

Clinical correlates of caudate volume in drug-naïve adult patients with obsessive-compulsive disorder.

The neurobiological basis of obsessive-compulsive disorder (OCD) has been theorized to reflect a dysfunction of cortico-striato-thalamo-cortical circuits, of which the caudate nucleus forms a critical component. However, structural imaging studies of the caudate in OCD are relatively scarce. To ascertain the clinical correlates of caudate volume in OCD, we report magnetic resonance imaging findings in a large sample of drug-naïve OCD patients in comparison with group-matched healthy controls. In this study, caudate volume was measured in coronal magnetic resonance brain images (high resolution 1-mm slice thickness) of 49 DSM-IV OCD patients and compared with that of 39 matched healthy controls. The caudate volume was measured separately for the head and body of the caudate. Analysis of covariance (ANCOVA) did not reveal significant differences in caudate volume between OCD patients and controls (whole group), with age, sex and intracranial volume as covariates. However, on examining the sexual dimorphism in the volume differences, male patients compared to male controls had significantly larger right caudate volume. The volume of the left caudate body showed a significant negative correlation with the total severity score on the Yale-Brown Obsessive-Compulsive Scale (YBOCS) on partial correlation analysis. Our study failed to show significant differences in caudate volumes between OCD patients and controls. However, it demonstrated a robust relationship between volume of the left caudate body and the severity of OCD. Additionally, there was a sexual dimorphism in caudate volume in OCD.

Dominant psychiatric manifestations in Wilson's disease: a diagnostic and therapeutic challenge!

INTRODUCTION: Recognition of psychiatric manifestations of Wilson's disease (WD) has diagnostic and therapeutic implications. OBJECTIVE: To describe the clinical features and psychopathology of patients with WD who had initial or predominant psychiatric manifestations. PATIENT AND METHODS: Records of 15 patients with WD (M:F: 11:4), from a large cohort of 350 patients, with predominant psychiatric manifestations at onset were reviewed. Their initial diagnosis, demographic profile, family history, pre-morbid personality, clinical manifestations, treatment and outcome were recorded. RESULTS: Their mean age at diagnosis was 19.8+/-5.8 years. Six patients were born to consanguineous parentage and two patients each had family history of WD and past history of psychiatric illness. Diagnosis of WD was suspected by detection of KF rings (all), observing sensitivity to neuroleptics (n=2), history of jaundice (n=2) and family history suggestive of WD (n=9). Psychiatric manifestations could be classified as affective disorder spectrum (n=11) and schizophreniform-illness (n=3). While the psychiatric symptoms improved in five patients with de-coppering therapy, seven patients needed symptomatic treatment as well. Three of the four patients who responded to de-coppering therapy were sensitive to neuroleptics. Long-term follow up of 10 patients revealed variable recovery. CONCLUSIONS: Young patient with psychiatric manifestations with clues like history of jaundice, family history of neuropsychiatric manifestations and sensitivity to neuroleptics should be evaluated for WD to avoid delay in diagnosis and associated morbidity. SIGNIFICANT OUTCOMES: The study reemphasizes the importance of behavioral manifestations in Wilson disease in terms of diagnosis and management difficulties. LIMITATIONS: Retrospective nature of the study.