Polycystic Ovary Syndrome and Obsessive-Compulsive Disorder: Interactions and Psychopharmacological Considerations.

[Author Affiliation]Timothy Rice. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Danielle Barcak. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Blanca Garcia-Delgar. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Barbara J. Coffey. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Address correspondence to: Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, E-mail: barbara.coffey@mssm.eduChief Complaint and Presenting ProblemM. was a 15-year-old adolescent girl with a history of panic attacks and school avoidance referred to an inpatient psychiatric unit after a suicide attempt.History of Present IllnessM. had a 2-year history of panic attacks, which started during the year before her transition from middle to high school. M. recalled that period as complicated, as she was rejected from the schools of her choice, and was subsequently placed at a local high school that was not well-known to her. One year before presentation, M. stopped attending classes regularly due to increasing anxiety, which resulted in failing grades and failure to be promoted to tenth grade. M. was subsequently enrolled at a new high school, but her attendance problems persisted. M. reported that the social worker of that school had threatened to call the Administration for Children's Services (ACS) for her poor attendance and had reportedly implied that her mother could consequently lose her job.Six months before presentation, M. started individual therapy with the goal of gaining coping skills and other means of self-regulation. During that time, M. was started on escitalopram at an unknown dose. M. did not find the medication effective after a 2-month trial as she continued to experience daily anxiety. She was switched to sertraline 100 mg 4 months before her presentation. In the month before presentation, M. reported experiencing about one panic attack per week--about five panic attacks in total. By that time, her sleep was restless and reduced; she experienced daytime fatigue, and had a tendency to overeat when anxious.On the morning of her suicide attempt, M. had planned to attend school. Father reported that she was putting on her shoes in preparation to leave for school when he and mother left the house for work. M. reported that she began to experience a panic attack immediately after they left, so she did not leave the house for school.M. reported feeling guilty for failing to attend school that day. She worried that her parents would be angry or that ACS would be called. She felt herself perseverating on the idea that "everything would be easier if I wasn't here," and "if my Mom loses her job, it's going to be my fault." Typically, M. would call her mother when she arrived at school in the morning; on that morning, M. refused to answer her cell phone or home phone.In this setting, M. placed a plastic bag over her head and held the handles of the bag close to her neck for about 1 minute, until she felt dizzy, at which time she removed the bag. M. reported that she intended to kill herself, but was not able to "go through with it." Motivated by guilt, M. reported her suicide attempt to her parents when they returned home from work. They immediately brought her to the Emergency Department of the nearest hospital.On interview in the Emergency Department, M. endorsed sweating, restlessness, fidgeting, increased respiratory rate, palpitations, clenched jaw, and crying during her reported panic attacks. M. endorsed feeling "out of control" and "like I'm going to die" and worrying about having another panic attack. M. also reported irritability, feelings of guilt, fatigue, poor concentration, hypersomnia, and nightmares with themes of "failure. …