Donna is a 41-year-old woman who is being evaluated at the request of her primary care provider for obsessive compulsive disorder
Donna is a 41-year-old woman who is being evaluated at the request of her primary care provider for obsessive compulsive disorder. As part of her medical history, Donna reported that her mother has been known to touch a door knob three times before entering the room and to check the stove multiple times before leaving the kitchen. Donna denies any similar symptoms, but it appears you do not share this information with your patients or discuss family history when assessing medical conditions.
Donna’s family medical history includes depression, substance abuse, and Alzheimer’s disease between relatives. She also reports having had a stutter as a child. Obsessive-compulsive disorder is linked to family psychiatric history, making the neurology referral important to rule out an underlying cause.
With a family history of both migraine headaches and stroke, Donna’s medical history should alert her primary care provider to the possible need for referral to a neurologist. A stroke is caused by interruption of blood supply to an area in the brain. The interruption may be caused by either a rupture or a clot within an artery supplying the brain. The most common symptoms of a stroke are sudden weakness on one side of the body and loss of sensation on one side of the face. A neurologist specializes in diagnosing and treating diseases of nerves, muscles and bones that affect movements and feeling.
Excessive care and concern is a description that best sums up how Donna grew up in a family full of encouragement. The earliest recollection seems to be the need to organize her toys in order of color and size. As she progressed through early education, Donna found herself transferring these obsessive tendencies toward grades and getting the “A” on all her papers. Each night before bed, she was treated to a goodnight kiss and hug, which would often turn into an extended squeeze as her mother and father showered their daughter with praise. As every Sunday afternoon approached, Donna’s parents planned what exciting activities would be done for the whole family in the upcoming week. There were weekly meals at their favorite restaurants on Wednesday nights where food was ordered using Donna’s meticulous rules.
Donna’s father experienced a severe head injury at age three. He also had recurring headaches and periods of confusion for the rest of his life. His mother was very nervous and developed tics that were treated with anti-anxiety medications.
It’s important to be able to recognize a family history of mental illness because this can greatly influence the way an individual develops their own illness. If your family has a long history of depression or schizophrenia, it is likely that you will develop the same illness. About 50% of individuals with obsessive compulsive disorder have at least one parent with mental illness.
Donna is a 41-year-old woman who is being evaluated at the request of her primary care provider for obsessive compulsive disorder. Which of the following aspects of Donna’s family medical history should prompt an immediate referral to a neurologist?