View source for WBR0041

{{WBRQuestion
|QuestionAuthor=Gonzalo Romero
|ExamType=USMLE Step 1
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=General Principles
|Prompt=A 17 yo male comes to the Outpatient clinic with his mom for a check up. His mom said he has developed a very strange behavior overtime which has increased in severity lately. Recently they went to have dinner as a family and she noticed he went to the restroom to wash his hands. He pushed the family restroom door and left it open with his foot to avoid touching the door handle. His mom stated that he washed his hands 4 times throughly and dried them with toilet paper. He exited the room as if he was going to perform a surgery. The family had ordered soft tacos for dinner and he ate without touching the food using the aluminum foil. His mom said that at home he always spends a lot of time in the restroom washing his hands, and that rewashes them if he touches the doorknob afterwards. The doctor asks him what his thought is about these repetitive actions. He says "I can't help it, I have tried to stop but I feel the urge to eliminate the germs on my hands before eating, I don't want to get sick, that's why I wash my hands" .  He had a good performance in class, sports and has some friends. On physical exam his vitals are stable, hands are severely dry and looks anxious. What is the most likely diagnosis?
|Explanation=This case scenario presents a patient with Obsessive-Complusive Disorder which is characterized by obsessions which focus on one thought, and compulsions which are repetitive actions to fix the bad thought. This teenager constantly thinks he has germs on his hands after he touches things and perceives this as threat to himself which might lead him to get sick; this is the Obsession. The repetitive washing behavior is washing his hands; this is the obsession. The patient recognizes this as absurds and tries to resist it. It is equally common in males and females. The main therapy involves the use of SSRIs such as Fluoxetine or Fluvoxamine. As supposed to the Obsessive-compulsive personality disorder they it is a focal and acquired disorder.

Source - Kaplan Medical STEP 1. Chapter 12 page 157.
|AnswerA=Generalized Anxiety Disorder
|AnswerAExp=This is an anxiety disorder which has symptoms varying more days than not, over a 6 month period. The symptoms includeL difficulty concentrating, insomnia, fatigue, motor tension, autonomic reactions (tachycardia, sweating, chest pain), hyperventilation, vigilance, restlessness, hyperactivity. 
|AnswerB=Obsessive Personality Disorder
|AnswerBExp=This type of disorder is long (extends for the entire lifetime) and it is pervasive, meaning that it extends to all areas of life. In this case the teenager recently acquired this behavior and only involves washing hands, not all areas of his life. Persons with this disorder are extremely organized, love lists, order, perfectionists, are stubborn, like routines, lacks sense of humor.
|AnswerC=Obsessive-compulsive disorder
|AnswerCExp=Correct answer, described above.
|AnswerD=Paranoid Personality Disorder
|AnswerDExp=It is a Cluster A or Eccentric Personality Disorder, which is characterized by a chronic mistrust of others, tries to look for hidden meanings into comments and carries grudges.
|AnswerE=Panic Disorder
|AnswerEExp=It is an anxiety Disorder, commonly presented in women. It must have 3 attacks in a 3-week period. It does not have a recognizable stimulus or phobia object. A Panic attack courses withL apprehension, fear, palpitations, hyperventilation, a feeling of unreality or going crazy.
|RightAnswer=C
|Approved=Yes
}}
{{WBRImage|Handwashing.jpg|http://en.wikipedia.org/wiki/File:Cuci_tangan_pakai_sabun.jpg|Explanation}}