Rarest of the rare: OCD complicates metabolic disorder, a case report.
Homocystinuria (HCU) is a rare metabolic disorder due to a defect in the cystathionine β -synthase (CBS) that leads to high homocysteine (Hcy) plasma. Clinically, HCU presents as a multisystem disorder with ocular, skeletal, cardiovascular, and central nervous system defects. Psychiatric manifestation have been documented in this disease ranging from anxiety, depression, oppositional disorder, ADHD etc. Till now only 1 study has shown a 5% prevalence of OCD with homocysteineurea (HCU) and no recent studies reporting obsessive-compulsive symptoms related to HCU have been found. The latest issue of Hindawi journal reports a case who developed obsessive-compulsive symptoms induced by homocystinuria.
Typical features, particularly in untreated patients, include early-onset severe myopia, osteoporosis, a tall thin marfanoid habitus, scoliosis, thromboembolic events in early adulthood, and variably decreased intelligence quotient (IQ).
A 39-year-old male, single, with no prior psychiatric history was admitted to the Emergency Department with behaviour changes and increased anxiety. In the last two months, he was restless, anxious, reporting multiple preoccupations with sever insomnia and tiredness and with increased worrying and become intrusive, unwanted, and repetitive and reported he had to write things down and reported difficulty in speaking.
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