Harish was apparently asymptomatic 2 years back when he was working in a private company. He was fired from his job when his boss wrongly claimed that he was irresponsible to work to the higher authority as he wanted to replace him. He later worked as a clerk in his wife uncle’s private school. Although got a new a job, he cannot get over the wrong things that had happened to him at his old job and due to his embarrassing traumatic past he’d get irritated, stress and anxiety over every trivial matters.

He also shows symptoms of obsessive compulsive disorder by maintaining self-disciplined and devoting himself to his new found job in fear of loosing the new job again which goes a little overboard for a while and later become extremely overboard towards everything. he would get violent and aggressive
towards his family over little things and would hit them if they don’t do it the way he wanted. Although he wants everything to be perfect, he couldn’t complete a task due to his difficulty in concentration and would get more irritated. He doesn’t want to be around people and isolate himself even from his family. He doesn’t want to get involved in any social functions either.

Due to his behavior was changed, he is in a borderline to lose his new job as well. The fear of losing his new job again increases his stress and anxiety.

He was taken to Psychiatric OPD by his wife and was admitted on the same day. He was later diagnosed as Obsessive compulsive disorder. Other associated disturbances were Sleep disturbance
Aggressiveness, Difficulty completing task, Loss of interaction
Self Isolation etc.

The patient belongs to a nuclear middle class family. He lives with his wife and two sons. He is working as a clerk in private school and is the breadwinner of the family. His wife owns a small grocery shop at their house and his two sons were still a students. The patient occasionally drinks alcohol but very rarely. Accept for alcohol he does not smoke or chew tobacco.
The patient got arranged non-consanguineous marriage by his parents choice. He has been married for 17 yrs now. Interpersonal relationship with family members, friends, colleagues were socially well adjusted. He was an Extrovert
personality and in his leisure time he used to Reading news paper, watching TV and occasionally playing cricket with sons. His Predominant mood was Confident, optimistic, cheerful, stable, Sincere and hardworking. while Attitude to others was quite Polite and having good manners towards others.

MENTAL STATUS EXAMINATION

After examining with all the questions, it was found that the patient’s Concentration, stream of thought and insight is impaired.
The Patient was asked to subtract numbers in which he was overwhelmed by the questions and was stress over the calculations has made and find it very difficult to concentrate and work his brain on the simple calculations. He was asked about his illness in which he replies “I’m not sick, I was just getting a little irritated over trivial matters because I want everything to be
perfect around me” that indicates his lack of insights.

TREATMENT
Early sessions were spent with the patient gathering some information and forming a working alliance. Although he showed a good response and finish his sentences and seemed focus on
conversations, there was lack of concentration on the topic discussed and he refused to accept his mental illness. He was given Tablet Clomipramine 25mg once a day before bed.
In the weeks ahead, sessions concentrated on educating patients about OCD, the symptoms, possible causes and treatment. His drug dose Clomipramine was increased to 50mg the
following week in which he also seems to show some positive response, he was more relaxed and calm.
Behavioral therapy with medications and supportive therapy to deal with his difficulties and problems were initiated for the next following week. And after several weeks he had shown
some improvement his behaviour as his overboard grooming, frequent cleaning of his hospital bed and surroundings becomes a little less often. After couple of months long treatment patient improved in his all symptoms and get back to normal life.