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L.O is woman who works as a graphic designer in a small advertising agency. She presented to her primary care physician with complaints of persistent anxiety and intrusive thoughts that were interfering with her daily life.L.O reports experiencing intense fear of germs and contamination. She would often spend hours washing her hands, sometimes until they became raw and irritated. repeatedly checked locks, appliances, and switches to ensure they were turned off or locked, even if she had already checked them multiple times. Patient started on paxil 20mg daily , Follow up in 2 weeks