Treatment of resistant obsessive-compulsive disorder (OCD) typically results in insufficient symptom alleviation, and even long-term medication often fails to have the intended effect. Ketamine is a potent non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Studies have shown that low-dose ketamine infusion results in a considerable reduction in obsessive-compulsive symptoms and a rapid resolution of suicidal ideation. This is a case report on the effect of intravenous ketamine infusion on a patient with resistant OCD and severe suicidal ideation. Intravenous (IV) ketamine was given once a week over consecutive three weeks with necessary precautions. Psychometric tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impressions Scale (CGI-S), the Beck Scale for Suicidal Ideations (BSSI), and Depression Anxiety and Stress Scale 21 (DASS-21) were applied before and after infusions. Obsessive-compulsive symptoms and suicidal severity started to decrease rapidly after the first infusion. However, after a transient improvement, these symptoms again began to increase after a stressful incident on the second day of the first infusion. All the symptoms measured by validated rating scales showed continued improvement after the following two infusions. The improvement was sustained until discharge (one week after the last infusion) and subsequent follow-up in the sixth and 12th weeks. The role of ketamine in reducing suicidal thoughts and behavior is already established. Very few studies emphasized its effectiveness in improving severe/resistant obsessive-compulsive symptoms. This pioneering work may offer scope for similar research in the relevant field.
Introduction Obsessive-compulsive disorder (OCD) is a persistent psychiatric condition that causes significant clinical and functional impairments. Recent research suggests a link between deficiencies in micronutrients, particularly vitamin B12, folic acid, and elevated homocysteine, and the development of OCD. This study investigates the blood levels of these micronutrients and their relationship to OCD severity, with an emphasis on potential gender differences. Methods This cross-sectional study included 300 drug-free OCD patients. Serum levels of vitamin B12, folic acid, and homocysteine were measured using established biochemical methods. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess clinical severity. Data were examined to determine relationships between micronutrient levels and OCD severity and differences between male and female patients. Results This study found that women had higher levels of vitamin B12 (405.3 ± 15.1 vs. 360.4 ± 14.3) and folic acid (7.18 ± 0.27 vs. 5.76 ± 0.25) but lower levels of homocysteine (9.35 ± 0.64 vs. 14.4 ± 0.60) compared to men. Higher folic acid levels were linked to study participants having higher levels of education (at a college or university, where subjects are studied at an advanced level) compared to those with primary-level education. Lower vitamin B12 levels were linked to family mental health history and noncommunicable diseases. Women exhibited lower levels of substance use but higher rates of self-harm and suicide attempts. Elevated homocysteine levels were linked to longer illness duration and more severe OCD symptoms. Conclusion These findings suggest that imbalances in micronutrients, particularly vitamin B12, folic acid, and homocysteine, may contribute to OCD severity and treatment resistance. Gender-specific variations in micronutrient levels could provide valuable insights into personalized OCD therapy choices. Further longitudinal studies are needed to understand these relationships and their potential as therapeutic targets.