MR in Psychiatry

This 14 year old male with no physical problems complained of smelling unpleasant odors for the past one year. During his psychiatric assessment he mentioned that he had compulsions in the form of tearing small pieces of paper into bits. He had thoughts of persecution, i.e. hostile thoughts about his father. Attention, concentration and memory were highly impaired. He was diagnosed with attention deficit by his previous doctor. Lack of attention had been a problem for him since he started school.

There was no history of inpatient stay and no psychiatric disorder in his family history. There were no attempts or thoughts of suicide. The patient was not smoking cigarettes or using alcohol or other substances. He had normal sleep, appetite and libido.

During the psychiatric assessment it became clear that the patient’s level of self-care and also his psychomotor activity had decreased. In his interaction with me he seemed reluctant. His emotional state was one of apathy and his emotions were out of place. With regard to the content of his thoughts, there was nothing specific other than his hostility towards his father. His mother said that he was hostile towards his father. His mind was clear.

The patient was a single child; his relationship with his mother was a good and close one. He was distant towards his father. He had not lost any academic years but during the last year his school performance had deteriorated. The patient, who had limited relations with his friends, underwent an EEG. The reason for this was that he was experiencing bad odors and his cognitive functions were becoming impaired. These are two symptoms which are more frequently encountered in organic cases. The EEG established teta and superimposed beta waves in the right temporo-occipital area.

An MR was requested. It revealed a 5×5 cm tumor near the right central and parieto-temporal area. Surgery was recommended, and until the surgery date the patient was advised to use antipsychotic, antidepressant and antiepileptic drugs. 20 days later the patient underwent surgery. During his post-operative examination one month later he was able to communicate and his reluctance had disappeared. He no longer detected bad odors and his compulsions were greatly reduced.

His thoughts of persecution towards his father had disappeared and their relationship had improved. There was no nonsensical talk anymore; previously there had been strange ideas of reference and conspiracy theories. Post-operatively these too disappeared. The patient no longer had positive symptoms and his compulsive symptoms had also improved. At his consultation in the second month the compulsions had completely disappeared. The only issues left were the reduced self-care and nervousness.

At the consultations during the subsequent months the nervousness had also completely disappeared. The young man who had now become a calm person was also more attentive to self-care. Apart from slight forgetfulness his cognitive functions were healthy.