2/28/2024 0 Comments Obsessive thoughts adhdHis primary OCD symptom is “taboo thoughts,” wherein he experiences intrusive images of stabbing his father with a kitchen knife. One year ago, he was diagnosed with OCD, adding to his long-standing preexisting diagnoses of TS and ADHD (with executive dysfunction). How should her primary care physician understand this new behavior in light of her known (neuro) psychiatric conditions? Is this a tic (as part of TS), a compulsion (as part of OCD), an impulsive behavior (as seen in ADHD), bad behavior, or something else?Īn 11-year-old boy, accompanied by his mother, met with his primary care physician. The thoughts and behaviors recurred, and she broke 2 additional tablets. In explaining how it broke, she told her parents that she had accidentally dropped the tablet, and they bought her a new one. Although she “absolutely” did not want to damage the tablet, the more she tried to push away the image, the more powerful it became-an all-consuming inner tension/turmoil that could only be relieved through biting into and cracking the tablet’s screen. Despite (or perhaps because of) her belief that this would be “the worst thing ever,” she became stuck on the image and unable to put it out of her mind. Shortly thereafter, she experienced an intrusive image of herself biting and cracking the tablet’s glass cover. While reflecting on the value and meaning of this gift, she realized how terrible it would be if she were to break the tablet. Several months ago, her parents purchased an expensive tablet for her. However, she described a behavior that had recently begun to interfere with her life. She had been receiving treatment for these conditions off and on since the age of 8 years and through hard work had managed to reduce the frequency of her obsessive thoughts, compulsive behaviors, and complex motor and vocal tics. * Corresponding author: Erica Greenberg, MD, Department of Psychiatry, Massachusetts General Hospital, Fruit St, Boston, MA 02114 ( you ever wondered why people act impulsively or compulsively? Have you ever been unsure whether certain behaviors are under someone’s control? Have you ever been frustrated when seemingly logical strategies to help change behaviors and emotional states are less effective than you had hoped? If you have, then these vignettes and the following discussion may prove useful by providing insights into intrusive-destructive behaviors (IDBs), a newly characterized construct.Ī 15-year-old girl with Tourette syndrome (TS), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD) arrived for an initial visit with a new primary care physician. © Copyright 2021 Physicians Postgraduate Press, Inc.ĪDepartment of Psychiatry, Massachusetts General Hospital, Boston, MassachusettsīHarvard Medical School, Boston, Massachusetts ![]() Intrusive-destructive behaviors: novel behavioral presentations of patients with co-occurring Tourette syndrome, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. To cite: Greenberg E, Petriceks AH, Stern TA. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. ![]() The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. ![]() ![]() LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY
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