28th National Clinical Education Symposium Presentation Abstracts
21 APRIL 2026, TUESDAY
PP-32 Combined Treatment Approach in Health Anxiety-Themed Obsessive
Ruminations: A Case Report
PP-32 Combined Treatment Approach in Health Anxiety-Themed Obsessive Ruminations: A Case Report
Süleyman Çankaya1, Özden Arısoy1
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Show more (Affiliations)
1. Department of Psychiatry, Abant Izzet Baysal University, Bolu, Türkiye
DOI: 10.5080/61upk.ozt521 Page 230
Combined Pharmacological and Cognitive-Behavioral Treatment in Health Anxiety Focused Obsessive Ruminations: A Case Report OBJECTIVE: Health anxiety-focused obsessive ruminations involve repetitive, functionally impairing mental preoccupations from realistic health risk perceptions. Triggers like medical imaging can intensify these cycles [1]. This report examines combined pharmacological and psychotherapeutic efficacy in a patient with resistant ruminations following her child's computed tomography (CT) scan. CASE: A 42-year-old woman presented with intense anxiety and ruminations regarding potential radiation-induced cancer in her son after a single CT.SCID-5-CV evaluation confirmed a DSM-5 diagnosis of Obsessive-Compulsive Disorder (OCD),Health Anxiety Focused, with Good or Fair Insight. No comorbid depressive or anxiety disorders were identified; subclinical generalized anxiety symptoms were noted. Initial scores:Y-BOCS 28, BAI 25, BDI 9. The patient frequently searched scientific articles, providing temporary relief but perpetuating ruminations. Mental status showed ego-dystonic thoughts with partial insight. Following clinical unresponsiveness to sertraline (200mg/day), fluoxetine (60mg/day), and aripiprazole (15mg/day), augmentation therapy was initiated. Per WFSBP guidelines and resistant OCD algorithms [3,4], venlafaxine was titrated to 300mg/day and quetiapine to 600mg/day. Concurrently, a structured 12-session Cognitive-Behavioral Therapy (CBT) protocol was implemented, including psychoeducation, cognitive restructuring (addressing catastrophizing and intolerance of uncertainty), managing reassurance-seeking, Exposure and Response Prevention (ERP), metacognitive techniques, and uncertainty exposure. At six months, Y-BOCS decreased to 10 and BAI to 8.However, ruminations flared when her son required a repeat CT for pneumonia; symptoms remitted after intensified supportive sessions and increased quetiapine dosage. Written informed consent was obtained. DISCUSSION: This case demonstrates the efficacy of combined pharmacological and structured CBT in health anxiety-focused ruminations. CBT addressed cognitive distortions through ERP and metacognitive techniques [2].SNRI (venlafaxine) and atypical antipsychotic (quetiapine) augmentation for resistant symptoms aligns with current guidelines [3,4].Environmental triggers' role in relapse underscores the necessity of treatment continuity and relapse prevention.Combined therapy ensures sustainable clinical well-being in symptom control and relapse management. Keywords: combination therapy, health anxiety, obsessive rumination, reassurance seeking behavior