| A Somatoform Variant of Obsessive-Compulsive Disorder: A Case Report of OCD Presenting With Persistent Vomiting. | |
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MedLine Citation:
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PMID: 15514688 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Acute nausea and vomiting are often self-limited or easily treated. Persistent vomiting, however, poses diagnostic and therapeutic challenges for the primary care physician. In addition to gastrointestinal, neurologic, and endocrine disorders, the differential diagnosis includes psychiatric illnesses, such as eating and factitious disorders. We present the case of a 52-year-old woman referred to the Tulane University Internal Medicine/Psychiatry clinic with persistent daily vomiting for 8 years despite repeated medical evaluations. The vomiting was of sufficient severity to require intensive care unit admission for hematemesis. A dually trained internal medicine-psychiatry house officer obtained further history and identified that the woman experienced an intrusive thought that urged her to vomit after each meal. Resisting the urge resulted in intolerable anxiety that was relieved only by vomiting. Obsessive-compulsive disorder (OCD) was diagnosed according to DSM-IV criteria. Initiation of escitalopram with titration to clinical response resulted in full symptom resolution and meaningful quality of life improvement. Pertinent literature was reviewed using 2 methods: (1) an English-language MEDLINE search (1966-February 2004) using the search terms vomiting and (chronicor psychogenicor psychiatric), and obsessive-compulsive disorder and (primary care or treatment); and (2) a direct search of reference lists of pertinent journal articles. A review of psychiatric etiologies of vomiting and primary care aspects of OCD is presented. Primary care clinicians are strongly encouraged to consider psychiatric etiologies, including OCD, when common symptoms persist or present in atypical ways. Such disorders can be debilitating but also responsive to treatment. |
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Authors:
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Robert D Kirkcaldy; Thomas J Kim; Caroline P Carney |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Primary care companion to the Journal of clinical psychiatry Volume: 6 ISSN: 1555-211X ISO Abbreviation: Prim Care Companion J Clin Psychiatry Publication Date: 2004 |
Date Detail:
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Created Date: 2004-10-29 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100887410 Medline TA: Prim Care Companion J Clin Psychiatry Country: - |
Other Details:
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Languages: ENG Pagination: 195-198 Citation Subset: - |
Affiliation:
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Departments of Internal Medicine and Psychiatry, Tulane University School of Medicine, New Orleans, La. ; and the Regenstrief Institute, Departments of Psychiatry and Internal Medicine, Indiana University School of Medicine, Indianapolis . |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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