Covid-19 Pandemic and Worsening of OCD Symptoms in an Adolescent

Background: Obsessive Compulsive Disorder (OCD) is a chronic and debilitating psychiatric condition. It is characterized by recurrent and persistent intrusive thoughts, urges or images (obsessions) and/or, repetitive behaviors or mental acts (compulsions) in response to the intrusive thoughts. The prevalence of OCD in childhood ranges from 0.5%–3%. It is thought that psychosocial stressors and trauma may worsen OCD symptoms. The COVID-19 pandemic and subsequent quarantine measures have been shown to cause stress and to be associated with a negative impact on psychiatric disorders. Although there is literature describing worsening of OCD and other psychiatric conditions in adults, little has been written about the worsening of obsessions and compulsions in children and adolescents during the COVID-19 pandemic. We report a case of worsening obsessive compulsive disorder symptoms in an adolescent during the COVID-19 pandemic which responded well to a therapeutic dose of sertraline.

Methods: Methods included case report and literature review using search terms obsessive-compulsive disorder or OCD and COVID or coronavirus. Search yielded 141 papers, of which 39 that were published since onset of COVID-19 pandemic in 2020 through February 2021 were considered most relevant. 5 papers included the words children, adolescents, university students or young people in the title.

Results: A 17-year-old female with history of obsessive-compulsive disorder suffered significant worsening of obsessions and compulsions during the COVID-19 pandemic which interfered with her functioning. Patient was referred for child and adolescent outpatient care and at the time presented with contamination obsessions and cleansing compulsions whereas prior to the pandemic she presented with checking obsessions and compulsions. Physical examination, vital signs and laboratory studies were within normal limits. Patient was asymptomatic for COVID-19 and COVID testing was not done due to limited availability of testing resources at that point in the pandemic. Severity of symptoms was assessed using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and Clinical Global Impression (CGI). CY-BOCS score was a 27. CG1-Severity was 4-Moderately ill. Improvement was observed with the titration of sertraline to a therapeutic dose. Patient reported a significant decrease in the frequency and severity of obsessions and compulsions. CGI-Improvement was a 2 (much improved).

Conclusions: The findings in this case are consistent with emerging literature regarding exacerbation of symptoms of obsessive-compulsive disorder, specifically those revolving around contamination, during the COVID-19 pandemic. Recent papers have highlighted increase in OCD symptoms during the pandemic in samples of university students in China and children and adolescents in Turkey, Denmark and Iran. To our knowledge, the present paper is the first to report on a case of exacerbation of OCD symptoms in an adolescent in this country. The case illustrates the importance of attention not only to potential increase in OCD symptoms but to change in symptom content with greater emphasis on contamination fears in the context of public health recommendations and extensive media coverage regarding safety measures including hand-washing and social distancing. Treatment approaches consistent with current guidelines from the American Academy of Child and Adolescent Psychiatry and other major professional organizations, including medical and psychiatric assessment, CBT with exposure and response prevention components, and selective serotonergic reuptake inhibitors (SSRIs), can be helpful in reducing OCD symptoms associated with the pandemic. Areas for future research include potential association between neurobiological sequelae of COVID-19 and OCD symptoms.