Dr. Saurabh Kumar
MBBS, M.D. (Psychiatry) 15 years experience overall Psychiatrist , Neuropsychiatrist , Sexologist
New Onset Obsessive Compulsive Disorder Following High Frequency Repetitive Transcranial Magnetic Stimulation over Left Dorsolateral Prefrontal Cortex for Treatment of Negative Symptoms in a Patient with Schizophrenia
Published In: Clinical Psychopharmacology and Neuroscience Journal
About Clinical Psychopharmacology and Neuroscience Journal: The Clinical Psychopharmacology and Neuroscience Journal is a prestigious peer-reviewed publication that provides a platform for cutting-edge research at the intersection of psychopharmacology and neuroscience. Renowned for its emphasis on novel clinical findings and their neurobiological underpinnings, the journal is a key resource for psychiatrists, neuroscientists, and clinicians dedicated to advancing the understanding and treatment of mental health disorders. The journal ensures rigorous peer review and maintains high standards of scientific discourse, making it a trusted publication for groundbreaking case studies and clinical trials.
Abstract
This thought-provoking case report, co-authored by Dr. Saurabh Kumar, Harshit Garg, Swarndeep Singh, Nand Kumar, and Rohit Verma, presents a groundbreaking observation in the field of psychiatry. Published in the Clinical Psychopharmacology and Neuroscience Journal, the article discusses a rare case of a patient developing new-onset Obsessive Compulsive Disorder (OCD) following high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) administered as an adjunctive treatment for the negative symptoms of schizophrenia. The report is particularly significant as it highlights the potential neurobiological connections between rTMS and OCD, providing a crucial perspective for clinicians and researchers alike.
Key Findings of the Research:
- Rare Association Between rTMS and OCD: The case report documents, for the first time, the emergence of OCD symptoms following high-frequency rTMS treatment over the left dorsolateral prefrontal cortex (Lt-DLPFC) in a patient with schizophrenia. This finding is highly novel, as it suggests that rTMS—commonly used to alleviate negative symptoms of schizophrenia—might have unintended effects on patients predisposed to certain neurobiological vulnerabilities.
- Clinical Presentation: The subject, an 18-year-old female with a longstanding diagnosis of schizophrenia, was treated with high-frequency rTMS to address persistent negative symptoms such as avolition and anhedonia. During the course of treatment, she began exhibiting obsessive-compulsive symptoms, specifically obsessive doubts about contamination, leading to compulsive washing behaviors. These symptoms developed toward the end of her rTMS sessions, marking a significant new onset of OCD.
- Neurobiological Implications: The report hypothesizes that the hyperactivity observed in the prefrontal cortex and the cortico-striatal-thalamo-cortical (CSTC) circuit, which are linked to OCD, might have been triggered by rTMS stimulation. This hyperactivity could have exacerbated the neural circuitry involved in obsessive-compulsive behaviors, thereby explaining the development of OCD in this case. While previous research has focused on rTMS's positive effects on schizophrenia, this report opens a crucial conversation about potential adverse effects.
- Therapeutic Response: Upon the development of OCD, the patient was treated with fluoxetine, which led to significant improvement in her obsessive-compulsive symptoms. Remarkably, the patient continued to maintain improvement in both OCD and schizophrenia symptoms during follow-up, with sustained benefits observed six months post-treatment.
Applicability to the General Population:
This case report carries substantial implications for the broader psychiatric and neurological fields. First and foremost, it raises awareness among clinicians about the potential risks associated with rTMS, particularly in patients with complex neurobiological profiles. While rTMS has been widely lauded for its therapeutic effects, this report suggests that, in some individuals, it may provoke new or exacerbate existing psychiatric conditions such as OCD.
For the general population, the study highlights the nuanced interplay between different neurobiological systems in the brain, particularly in patients with co-occurring psychiatric disorders. It underscores the importance of personalized treatment approaches in psychiatry, where therapeutic interventions must be carefully tailored to account for a patient's unique neurological makeup. The research also advocates for ongoing monitoring and comprehensive follow-up in patients undergoing rTMS, ensuring that any emerging side effects are promptly addressed.
In conclusion, this case report not only documents a rare clinical phenomenon but also opens new avenues for research into the complex interactions between psychiatric treatments and neurobiology. It calls for further studies to investigate the mechanisms behind rTMS-induced OCD, ultimately contributing to safer and more effective treatment strategies for individuals suffering from schizophrenia and other psychiatric disorders
Author Information: Garg, Harshit, Saurabh Kumar, Swarndeep Singh, Nand Kumar, and Rohit Verma. "New onset obsessive compulsive disorder following high frequency repetitive transcranial magnetic stimulation over left dorsolateral prefrontal cortex for treatment of negative symptoms in a patient with schizophrenia." Clinical Psychopharmacology and Neuroscience 17, no. 3 (2019): 443.
View Original Research