Brief Answer:
namenda (memantine) is recommended

Detailed Answer:
Hello XXXXXXX

Thanks for contacting back directly again.

As such no specific role of topamax has been identified in OCD. Only one or two studies have suggested some possible role. I have never used it in OCD.

Namenda of course has shown some results in treatment resistant OCD. Though no large scale study to decide its efficacy has been done, it has shown almost 25% improvement in few studies. It should be added to other drugs. I have used in 8-10 patients with 20-30% further improvement. Typically no major side effect is there and no test is needed to start it. If I were your treating doctor I would try namenda first.

From our previous discussion keep the options in mind like clomipramine and divalproate sodium for severe impulse like thoughts.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

---

Brief Answer:
MRI brain scan,EEG and rorschach test

Detailed Answer:
Hi,

Thanks for follow up.

I recommend MRI brain scan,EEG and rorschach test when there is no response to drug.

MRI brain is suggested to check any minor/major abnormality which is contributing to your problem.

EEG is to check for any abnormal brain waves and possible use of anti epileptic medicine.

Rorschach test is psychological test to check for depressive, psychotic and obsessive thoughts.

Feel free to discuss further.

---

Brief Answer:
Then it is OCD only

Detailed Answer:
Hi,

Thanks for information.

When MRI brain and EEG normal , your diagnosis should be OCD.

For your information I am writing diagnostic criteria here.

A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.


B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders;
guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).

Hope from this you can confirm your diagnosis.

You are welcome to clear more doubts.

Regards.

---

Brief Answer:
yes it is

Detailed Answer:
Hi,

Yes if your thoughts of setting yourself on fire are unwanted, intrusive and you want to get rid of them, this is OCD.
I would like to give one example in which one lady has OCD of thoughts of killing her children with kitchen knife. She was treated with medicines and cognitive behavior therapy.

All the best.

You can continue this discussion if you have more queries or you can close the same and you are welcome for future queries on

http://bit.ly/drchintansolanki

as you did this time.

---