Semeion Life Center

    Suzy, 19, arrived at LifeBridge struggling with anxiety, moodiness, racing thoughts and depression for the past 12 years. She reports that her “brain is very powerful, but during the last few months, I’ve been getting only four hours of sleep, because I can’t stop it. I get anxious about everything. My brain never loses conscientiousness. It’s so difficult being so different and alone. I’m always in pain and never feel good physically. I get nothing out of exercise and when I’m on medicines, I only get the negative side-effects. I tried drugs, alcohol and even smoked pot clinically. Nothing helps.”

Case description

    Suzy began treatment for her systems at the age of 7. She has seen multiple psychologists and psychiatrists receiving a variety of different diagnosis including OCD, major depressive episodes, generalized anxiety disorder. Treatment regimens have included psychotherapy, multiple anti-depressants, sleep aids, anxiolytics, anti-psychotics, and stimulants. Despite multiple providers and treatment regimens, Suzy presented with the chief complaint that “nothing appears to be working to stabilize my brain”.

Imaging OCD/Bipolar

    SPECT imaging studies, comparing baseline to concentration, revealed the following:
1. Significantly decreased tracer activity in three parasagittal areas that decrease marginally to two locations with concentration.
2. Increased right thalamic tracer activity seen on both studies, asymmetrical and equal on baseline and concentration studies.
3. Increased left and right basal ganglia and insular tracer activity seen on both studies, more prominent in the left side and more intense with concentration.
4. Decreased left and right temporal lobe tracer activity seen on both studies
5. Significantly increased uptake in the anterior cingulate gyrus in both scans.
6. Significant uptake in the cerebellum both at rest and at concentration.
7. Increased patchy uptake of the prefrontal  cortex.
8. Combination of increased uptake in the cingulate gyrus, the basal ganglia and the thalamic nuclei.

LifeBridge Treatment Plan

    Medication trials will need to take into consideration both the OCD and bipolar spectrum, since first line SSRI’s for OCD without a mood stabilizer will aggravate cycling. She will most likely benefit from combination psychopharmacology due  to her varied symptom profile.
    Consideration for a pure anti-anxiety agent such as BuSpar maybe beneficial along with a possible beta-blocker, especially since she has a needle phobia.
Another consideration is Topamax, which has evidenced success with stabilizing mood and decreasing irritability