Concluded Case

One hand growing bigger than the other.

A 47 year old female was brought to OPD with preoccupation and repetitive thoughts about her right hand getting bigger than the left and in due time it would grow to extent that it would make her look grosteque. She has been checking it regularly marking her right hand to the extent it grows everyday and expresses desire to undergo surgery to prevent it. Her husband expressed fear as similar events occurred 3years back while she felt that her nose is deforming and that hampers with her sense of smell and was hellbent to correct it and underwent surgery for the same. Also she has a love for keeping all the things at home in a particular order and symmetry and has been staying aloof in a room not allowing anyone to enter and cleans the whole room if anyone does. It takes her 3hours to complete her bathing while she cleans the whole bathroom twice and then the buckets and taps and then if the soap or shampoo drops on the ground she repeats the whole ritual again. During the initial days of her marriage she expressed a sense of guilt on multiple occassions but refrained from telling the reason for it. She used to repeat it again and again that the world we live in is full of dirt and evil deeds that needs to be correctly and there is no particular way to do so. The total duration of her illness is 15 years. Kindly comment on the nature of her disorder and method of treatment.

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Concluded answer

Here the women with anankastic traits no doubt presenting with obsessive symptoms but her major compliant is rt hand getting bigger and previous history of nose being deformed ( somatic delusion) so my diagnosis wud be delusional disorder with obsessive symptoms differential diagnosis of body dysmorphic disorder and depression with psychotic symptoms. She shud be managed with 2nd generation antipsychotics and SSRI ( for her obsession) with psychotherapy sessions.

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Acromegaly is a rare disorder that is caused by excess levels of growth hormone (GH) in the body. In most patients, excess levels of GH are causes by a benign (noncancerous) tumor in the pituitary gland (pituitary adenoma). Or maybe hemihyperplasia. What is hemihyperplasia? Hemihyperplasia, formerly called hemihypertrophy, is a rare disorder in which one side of the body grows more than the other due to an excess production of cells, causing asymmetry. In a normal cell, there is a mechanism that turns off growth once the cell reaches a certain size. As for hemihyperplasia there is no cure for hemihyperplasia. Treatment is centered on screening the patient for tumor growth and treating the tumors. For abnormal limb size, orthopedic treatment and corrective shoes can be recommended As for acromegaly there are certain tests- Blood tests: Growth hormone and IGF-I blood tests measure different types of growth hormone levels in your blood. If these levels are high, your doctor might order a glucose tolerance test to confirm an acromegaly diagnosis. Glucose tolerance tests tell doctors whether your body’s growth hormone levels react to glucose (sugar) the way they should. For this test, you’ll have blood taken at different intervals after you drink a glucose solution. Imaging tests. Acromegaly treatment requires- Medication Radiation therapy Surgery For OCD the medication will be SSRI but in this case it won't be good to give SSRI so it would be better to send her to clinical psychologist for congnitive therapy. And as for the problems it would be better to prefer her to a neurosurgeon

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Here the women with anankastic traits no doubt presenting with obsessive symptoms but her major compliant is rt hand getting bigger and previous history of nose being deformed ( somatic delusion) so my diagnosis wud be delusional disorder with obsessive symptoms differential diagnosis of body dysmorphic disorder and depression with psychotic symptoms. She shud be managed with 2nd generation antipsychotics and SSRI ( for her obsession) with psychotherapy sessions.

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Obsession compulsive disorder with psychotic symptoms.

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Possible Body Dysmorphic Disorder with OCD (Mixed) Treatment : CBT with ERP, Behaviour therapy and SSRI

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