title: Compulsive carnival song whistling following cardiac arrest: a case study.
abstract: BACKGROUND
  Compulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments.
  
  
  METHODS
  A 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling.
  
  
  CONCLUSIONS
  This case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.
authors: Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands. a.r.polak@amc.nl
authors: A Rosaura
authors: AR
authors: Polak
authors: Jasper W
authors: JW
authors: van der Paardt
authors: Martijn
authors: M
authors: Figee
authors: Nienke
authors: N
authors: Vulink
authors: Pelle
authors: P
authors: de Koning
authors: Miranda
authors: M
authors: Olff
authors: Damiaan
authors: D
authors: Denys
mesh_terms: D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D058256:Brain Waves / Q000502:physiology; D002997:Clomipramine / Q000627:therapeutic use; D003192:Compulsive Behavior / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D004569:Electroencephalography; D006323:Heart Arrest / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D063346:Singing
chemical_list: D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine