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Hoi Ki Cheung

2 papers in the library · publishing 2026

Papers

Optimized Oral Glutamatergic Augmentation in Refractory Home-Dominant Contamination Obsessive-Compulsive Disorder With Somatic, Affective, and Motivational Features: A Case Report of Incremental Functional Gains.

Cureus June 1, 2026 Hoi Ki Cheung, Ngo Cheung

A 26-year-old woman with severe contamination-focused obsessive-compulsive disorder (OCD) that persisted despite standard treatments showed meaningful improvement after a glutamatergic augmentation strategy using dextromethorphan, piracetam, and L-glutamine, combined with CYP2D6-inhibiting antidepressants. Over nine months, bathing time decreased from about 1.5 hours to about 30 minutes, and ritual preoccupation reduced by 20-30%. Mood, energy, motivation, and daily functioning improved, and passive suicidal ideation resolved temporarily. Residual cleaning symptoms remained at home. The case is hypothesis-generating and not evidence of regimen-specific efficacy; larger controlled studies are needed.

DOI: 10.7759/cureus.111573 (opens in new tab) Full text (opens in new tab) Synaptic plasticity Contamination OCD Cyp2d6 inhibition Dextromethorphan +6

Differential Improvement in Obsessive Rumination and Fantasy Intrusions Versus Attachment-Related Emotional Dysregulation During Oral Glutamatergic Augmentation in a 16-Year-Old Adolescent.

Cureus July 1, 2026 Hoi Ki Cheung, Ngo Cheung

A 16-year-old female with moderate depression and severe anxiety, including obsessive rumination and difficulty distinguishing fantasy from reality, received a treatment regimen combining dextromethorphan, a CYP2D6-inhibiting antidepressant, piracetam, and risperidone. Over six months, depressive and anxiety symptoms improved to mild ranges, and obsessional symptoms reportedly reduced by more than 30% after dextromethorphan escalation and piracetam introduction. The patient showed better ability to interrupt rumination and improved fantasy-reality differentiation. No side effects were documented. The authors suggest NMDA-AMPA modulation may help adolescents disengage from rigid perseverative loops, but caution that polypharmacy and other factors limit interpretation.

DOI: 10.7759/cureus.112492 (opens in new tab) Full text (opens in new tab) Adolescent obsessive-compulsive symptoms Cyp2d6 inhibition Dextromethorphan Glutamatergic augmentation +1