Abstract
Obsessive compulsive disorder (OCD) is a fairly common disorder with lifetime prevalence rates in the range of 1.9–2.5%, across multinational sites [1]. In most studies, the mean age at onset is usually between mid- to late 20s to early 30s. While the Epidemiological Catchment Area (ECA) study reported that the prevalence rate in the 65 years and over age group was 1.2% [2], it is uncommon for OCD to begin for the first time in old age [3]. Kumar et al. [4] reported a 75-year-old woman with diffuse cerebral and cerebellar atrophy on CT scan, who presented with acute onset of obsessive compulsive symptoms. We report a case of late-onset OCD in a patient with a positive family history of OCD.
Mr M was an 80-year-old retired professor of language, premorbidly well-adjusted, who presented with a 15-year history of OC symptoms. Soon after retiring from his professorship around the age of 65, he started having obsessive doubts of having made mistakes while writing or translating any literary matter or even while writing letters to family members or friends. He also started having obsessive thoughts about the various trivial mistakes that he had made and various minor incidents in the past as well as obsessive fear that he was going to get emaciated, fall ill and lose all his hair. In order to reduce the anxiety caused by these thoughts, he recited God's name repeatedly in his mind. All these symptoms had gradually increased over the years, causing significant distress and impairment of function. He commenced taking benzodiazepines for relief from the anxiety, developing tolerance and switching from one agent (alprazolam) to another (diazepam) over time. Magnetic resonance imaging studies of his brain were normal.
Mr M was started on fluvoxamine up to a dose of 200 mg/day. After 2 months, his OC symptoms were much improved.
One of his sons also suffered from OCD, with onset at age 15, and with an episodic course, characterized by obsessive fears of untoward events happening to him and close family members, magical thinking, doubts and checking compulsions.
This case highlights that OCD may manifest for the first time in elderly patients without any structural abnormality of the brain. It is significant that the patient had onset at a later age despite having a family history of illness. The later age of onset in the father and earlier age of onset in the son raises the possibility of anticipation in familial OCD.