Case Report
Executive Dysfunction and Language Deficits in a Pediatric
Patient with OCD and MDD with Suicidality
Melissa Yuan
New York Presbyterian Hospital Westchester Division, White Plains, NY, USA
Correspondence should be addressed to Melissa Yuan; mey2010@med.cornell.edu
Received 12 February 2019; Accepted 18 April 2019; Published 30 April 2019
Academic Editor: Lut Tamam
Copyright © 2019 Melissa Yuan. Tis is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Te role of neuropsychiatric testing in psychiatric disorders is becoming more prominent. Neuropsychological measures that are
similar across symptom domains and phenomena such as suicidality may help clinicians guide treatment and tailor therapies to
the patient in the most efective way possible. We report the case of a 16-year-old girl who presented with bizarre, intrusive suicidal
thoughts in the setting of OCD and MDD. Tis case is unusual in that we have accurate neuropsychological determination of our
patient’s language and executive function defcits, and we propose a link between them and her expression of suicidality in the
context of OCD and MDD.
1. Introduction
In recent years, increasing focus is being turned towards
defning patterns of neuropsychological dysfunction that are
associated with specifc mental illness and specifc symp-
tom clusters, including bipolar disorder, attention-defcit
hyperactivity disorder, posttraumatic stress disorder, and
schizophrenia [1–5]. Tis is largely due to a shif towards
investigating brain structure and function underlying psy-
chiatric disorders [6]. An example of this is the attempt
to defne the neuropsychological attributes of people who
attempt suicide. In adults, it has been found that suicidal
ideation may result from dysfunctional frontal lobe executive
decision-making [7]. Additionally, previous studies have also
found that reduced verbal fuency is more common in suicide
attempters than a comparable control group [8].
In addition to defning phenomena such as suicidal-
ity, fnding neuropsychological measures that are similar
across various disorders is of interest. For instance, exec-
utive dysfunction is considered to be a state-dependent
feature of major depressive disorder (MDD), a state or trait-
dependent feature of obsessive-compulsive disorder (OCD),
and a possible endophenotype for suicidality. However, the
feld continues to lack a clear consensus on what these
neuropsychiatric “signatures” consist of, especially in the less-
studied pediatric psychiatric population, nor has the utility of
these been established. For example, there is mixed literature
regarding executive function in children with OCD. Beers et
al. found that recently diagnosed children with OCD did not
perform worse than healthy controls on neuropsychological
testing [9]. Tis fnding was replicated by Abramovitch et
al., who found that pediatric patients with OCD do not have
signifcant neuropsychiatric performance defcits [10].
It has been postulated that children with disruptive
behavior disorders may have poorer receptive, pragmatic,
and expressive language skills [11]. Tis has been shown in
attention-defcit hyperactivity disorder and other disruptive
behavior disorders, in the pediatric population [12–14]. Tis
has been shown less consistently in OCD and other disorders
[15].
We present a pediatric patient with comorbid MDD and
OCD with intrusive suicidal thoughts, who had measurable
defcits in executive function and language fuency on neu-
ropsychological testing. We believe that this is a timely report
of a complex patient that highlights the neuropsychiatric
correlates of various psychiatric symptoms and how this can
inform treatment.
2. Case Presentation
A 16-year-old female with a history of OCD, MDD, and
suicidal thoughts, with no past psychiatric hospitalizations,
Hindawi
Case Reports in Psychiatry
Volume 2019, Article ID 6574304, 3 pages
https://doi.org/10.1155/2019/6574304