Obsessive-Compulsive Symptoms in Schizophrenia: an Up-To-Date Review of Literature

Overlap of obsessive compulsive and psychosis risk symptoms in a specialized clinic

AIM

Psychotic disorders and obsessive-compulsive disorder (OCD) commonly co-occur. Likewise, subthreshold psychosis symptoms (clinical high risk for psychosis; CHR) and obsessive compulsive symptoms (OCS) often overlap and may be difficult to differentiate. This study aimed to replicate research investigating the prevalence of OCD in a CHR clinic sample, validate and investigate factor structure of a self-report OCS measure in a CHR sample, explore how OCS may relate to CHR and co-occurring symptoms, and investigate whether real-world CHR treatment improves OCS and CHR symptoms.

METHOD

This study analysed archival clinical data from baseline and 6-month follow-up assessments collected by a specialist outpatient CHR clinic. Data included assessments of CHR symptoms, OCS, and clinician-rated diagnosis. Exploratory factor analysis examined the OCS measure.

RESULTS

Within this CHR clinic sample, 13.5% experienced co-morbid OCD. The self-report OCS measure had two factors: (1) checking and counting behaviours and (2) intrusive thoughts and images of harm/guilt. The checking and counting factor correlated with depression and social anxiety. The intrusive thoughts and images of harm/guilt factor significantly correlated with unusual thought content and social anxiety. Between baseline to 6-month follow-up, clients exhibited CHR symptom improvement regardless of OCD diagnosis. However, OCS did not change.

CONCLUSIONS

These findings support validity of a self-report OCS measure in a CHR clinic sample and that types of OCS experiences may exhibit different clinical patterns. Additionally, it appears that individuals with comorbid OCD responded similarly to CHR treatment compared to those without OCD.

Parental mental disorders in patients with comorbid schizophrenia and obsessive-compulsive disorder: a nationwide family-link study

Schizophrenia is highly comorbid with obsessive-compulsive disorder (OCD); both conditions share numerous pathophysiological etiologies. We, thus, examined the risk of mental disorders in the parents of probands with schizophrenia, OCD, or both conditions. Between 2001 and 2011, we enrolled a nationwide cohort of 69,813 patients with schizophrenia, OCD, or both. The control cohort included 698,130 individuals matched for demographics. Poisson regression models were employed to examine the risk of six mental disorders in their parents, including schizophrenia, bipolar disorder, depressive disorder, OCD, alcohol use disorder, and substance use disorder. We stratified patients into schizophrenia-only, OCD-only, and dual-diagnosis groups, and the dual-diagnosis group was further divided into schizophrenia-first, OCD-first, and simultaneously diagnosed groups. Compared with controls, the schizophrenia, OCD, and dual-diagnosis groups had higher risks for the six mental disorders in their parents (range of odds ratio [OR] 1.50-7.83). The sub-analysis of the dual-diagnosis group showed that the schizophrenia-first, OCD-first, and simultaneously diagnosed groups had higher odds for schizophrenia, bipolar disorder, depressive disorder, and OCD (range of OR 1.64-6.45) in their parents than the control group; the simultaneously diagnosed and OCD-first diagnosed groups had a higher odds of parental substance use disorder, while the schizophrenia-first diagnosed group had a higher odds of parental alcohol use disorder. The interrelationship between OCD and schizophrenia is linked to bipolar disorder, depressive disorder, alcohol use disorder, and substance use disorder. The results have implications for mental health policy and future research.

Clinical profile of schizophrenia comorbid with obsessive-compulsive symptoms: A comparative study

OBJECTIVE

Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients.

METHODS

A descriptive and analytical cross-sectional study was carried out at the psychiatry department of Hassan II University Hospital in Fez over 12 months to compare three groups of patients: "schizo-obsessive" (n=32), "schizophrenia" (n=34), and "OCD" (n=46). All participants (n=112) were assessed using the mini-international neuropsychiatric interview (MINI), the Yale-Brown obsessive-compulsive scale (Y-BOCS), the Brown assessment of beliefs scale (BABS), the Hamilton anxiety rating scale (HAM-A), the Beck's depression inventory (BDI-II), the positive and negative syndrome scale (PANSS), and the clinical global impressions-severity scale (CGI-S).

RESULTS

The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P<0.001), higher anxiety (mean=8.87±5,655, P<0.001) and depression (mean=7.50±5.989, P<0.001) scores, more prevalent suicide attempts (46.9%), higher illness severity score (mean=5.13±1.157, P=0.02), and more professional disinsertion (78.1%). The "schizo-obsessive" group (mean= 14.47±3.388) had significantly poor insight (P<0.001) compared to the "OCD" group (mean= 8.35±4.542). There were similarities in the obsessive and compulsive themes between the "schizo-obsessive" and the "OCD" groups, with no significant difference of severity (P=0.26).

CONCLUSION

A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.

Obsessive-compulsive symptoms and disorder in clozapine-treated schizophrenia

BACKGROUND

Obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) are commonly reported in patients with schizophrenia. Furthermore, the use of clozapine in treatment-resistant schizophrenia has been thought to induce or aggravate these disorders. To date, there is a paucity of research regarding the prevalence and associated factors. Hence, this study aims to report the prevalence of OCS and OCD, and examine potential risk factors, in clozapine-treated schizophrenia.

METHODS

This is a cross-sectional study conducted in the only tertiary hospital for psychiatric patients in Singapore. In total, 162 patients on a stable dose of clozapine were recruited for this study; 159 patients with a diagnosis of schizophrenia or schizoaffective disorder were included in the current analysis. Sociodemographic, clinical and treatment factors were analysed to identify factors associated with OCS and OCD.

RESULTS

The prevalence of OCS and OCD is 21.4% and 12.6% respectively. Factors associated with OCS include younger age (OR:0.96, p=0.033) and younger age of onset of psychosis (OR:0.92, p=0.017). There were no significant factors associated with OCD. However, in an analysis of both OCS and/or OCD, factors associated include younger age (OR:0.96, p=0.027) and younger age of onset of psychosis (OR:0.91, p=0.016). Severity of psychotic illness and Clozapine dose were not associated with OCS or OCD in clozapine-treated schizophrenia.

DISCUSSION & CONCLUSIONS

Our results suggest a high prevalence of OCS and OCD in clozapine-treated schizophrenia which clinicians should routinely screen for. Further research is warranted to establish the link between the factors identified in this study and OCS/OCD in clozapine-treated schizophrenia.

Different degrees of nodes behind obsessive-compulsive symptoms of schizophrenia

Obsessive-compulsive symptoms are frequently observed in various psychiatric disorders, including obsessive-compulsive disorder, schizophrenia, depression, and anxiety. However, the underlying anatomical basis of these symptoms remains unclear. In this study, we aimed to investigate the mechanism of schizophrenia with obsessive-compulsive symptoms by using diffusion tensor imaging (DTI)-based structural brain connectivity analysis to assess the network differences between patients with obsessive-compulsive disorder (OCD), patients with schizophrenia showing obsessive-compulsive symptoms (SCH), schizophrenia patients with obsessive-compulsive symptoms due to clozapine (LDP), and healthy controls (CN). We included 21 patients with OCD, 20 patients with SCH, 12 patients with LDP, and 25 CN. All subjects underwent MRI scanning, and structural brain connections were estimated using diffusion tensor imaging for further analysis of brain connectivity. The topology and efficiency of the network and the characteristics of various brain regions were investigated. We assessed baseline YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS), Positive and Negative Syndrome Scale (PANSS), and 24-item Hamilton Depression Scale (HAMD-24) scores. Our results showed significant differences among the SCH, OCD, and CN groups (p < 0.05) in the MRI-measured degree of the following nodes: the superior orbitofrontal gyrus (25Frontal_Med_Orb_L), lingual gyrus (47Lingual_L), postcentral gyrus (58Postcentral_R), and inferior temporal gyrus (90Temporal_Inf_R). Additionally, we found significant differences in the degree of the brain regions 02Precentral_R, 47Lingual_L, 58Postcentral_R, and 90Temporal_Inf_R between the CN, OCD, SCH, and LDP groups (p < 0.05). These findings suggest that alterations in the degree of nodes might be the mechanism behind obsessive-compulsive symptoms in schizophrenia.

How Obsessive-Compulsive Symptoms Correlate with other Symptoms and Quality of Life in Schizophrenia? A Cross-Sectional Study

Background

Early psychiatrists inferred that obsessive-compulsive symptoms (OCS) represent a defense against psychosis and prevent the progression of schizophrenia. However, recent clinical research has yielded inconsistent results across studies regarding the link between OCS and the symptom domains of schizophrenia and the influence OCS have on a patient's functioning and quality of life (QOL).This study aimed to determine whether OCS has any association with the symptom severity, functioning, and QOL of schizophrenia patients.

Methods

This cross-sectional study done in a tertiary care hospital consecutively recruited 85 outpatients of schizophrenia in clinical remission over one year. Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), WHO Quality of Life Brief Version (WHO QOL-BREF), and Global Assessment of Functioning (GAF) scales were applied.

Results

Eighteen patients (21.2%) had OCS (Y-BOCS score of ≥8). Patients with OCS had higher PANSS scores (mean±SD of total score 77.16± 16.4, P < 0.001), suggestive of more severe psychosis, poor functioning overall (mean GAF score 37.35 ± 15.62, P < 0.001), and poor QOL in the psychological domain (P < 0.001). In addition, significant associations were present between the Y-BOCS score and the PANSS (r = 0.65), GAF (r = -0.61), and WHO QOL BREF scores in the physical (r = -0.39), and psychological domains (r = -0.41) (P < 0.001 on all of the above).

Conclusions

Patients with OCS have more severe symptoms and a lower QOL. A significant association exists between the intensity of OCS and schizophrenia symptoms, global functioning, and QOL.

Case report: Treatment-resistant schizophrenia with auto-aggressive compulsive behavior-Successful management with cariprazine

The present case report describes a patient with treatment-resistant schizophrenia and auto-aggressive compulsive behavior who was effectively treated with a third-generation antipsychotic medication, cariprazine. The diagnosis was made 12 years ago, and the patient has been hospitalized 14 times and undergone various antipsychotic treatments. Despite receiving both inpatient and outpatient care, the patient's response to treatment has been only partial, and he has been classified as a treatment-resistant case. Therefore, the patient was switched to cariprazine, which led to significant improvements in both positive and negative symptoms, as well as the complete reduction of auto-aggressive compulsive behavior. These improvements contributed to the patient's overall social functioning and the achievement of remission, while also avoiding polypharmacy and eliminating the metabolic side effects associated with previous treatments.

Obsessive-Compulsive, Psychotic, and Autism Dimensions Overlap in Real World: A Case Report

BACKGROUND

Obsessions, compulsions, and stereotypes are common psychopathological manifestations of obsessive-compulsive, psychotic, and autism spectrum disorders (ASDs). These nosological entities may be present in comorbidity, with relevant clinical difficulties in the differential diagnosis process. Moreover, ASDs are a complex group of disorders, with a childhood onset, which also persist into adulthood and present heterogeneous symptom patterns that could be confused with psychotic disorders.

METHODS AND RESULTS

We report a case of a 21-year-old man characterized by sexual and doubt obsessions; disorganized, bizarre, and stereotyped behaviors and compulsions; and social withdrawal, inadequate social skills, visual dispersions, and hypersensitivity to light stimuli. Obsessive and compulsive features were initially included within the differential diagnosis of psychotic and obsessive-compulsive spectrum disorders. However, aforementioned psychopathological elements did not improve when multiple antipsychotic drugs (olanzapine, haloperidol, and lurasidone) were administered in the hypothesis of schizophrenia and even worsened with clozapine therapy at a dose of 100 mg/d. Obsessions and compulsions progressively reduced during the fluvoxamine 14-week treatment paradigm at a dose of 200 mg/d. Considering the persistent deficits in social communication and interactions as well as the restricted interests pattern, a differential diagnostic hypothesis of ASD was formulated, and it was then confirmed at the final evaluation at a third-level health care center.

CONCLUSIONS

We discuss similarities and differences in the psychopathology of obsessions, compulsions, and stereotypes in the previously mentioned disorders, to underline factors that can help in the differential diagnosis of similar cases, and consequently in the appropriateness of treatment choice.

Treating a Case of First-Episode Psychosis to Uncover Undiagnosed Obsessive Compulsive Disorder: A Case Report

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition characterized by the presence of obsessions, compulsions, or both. Historically OCD was associated with good insight. However, there are more categories to the degrees of insight in OCD patients, namely good, fair, poor, absent, or delusional beliefs. It is also important to note that insight can fluctuate circumstantially. We describe a rare case of first-episode psychosis of undetermined cause presenting with suicidal ideation. After continued treatment, it was discovered to be previously undiagnosed OCD with poor insight.

Obsessive-compulsive symptoms in the schizophrenia-spectrum: current developments in psychopathology research

PURPOSE OF REVIEW

Schizophrenia-spectrum disorders (SSD) frequently involve symptoms that usually are ascribed to nonpsychotic disorder spectra, such as obsessive-compulsive symptoms (OCS). These symptoms can cause differential diagnostic challenges, particularly in early illness stages, and must be considered in treatment planning. In this review, we provide an overview of recent literature within the field of OCS in SSD, with a focus on psychopathology research.

RECENT FINDINGS

OCS are seen in approximately a quarter of patients with SSD or at-risk mental state of psychosis. They are associated with more severe clinical features and specific temporal patterns of OCS may be linked with different clinical trajectories. However, the current definitions of OCS have been criticized for their overinclusive nature, which is a limiting step for differential diagnosis and more precise prognostic stratification. Specific phenomenological features, including a link with experiential anomalies (disorders of basic self), have been suggested to provide clinically relevant distinctions.

SUMMARY

The presence of OCS in SSD is associated with more severe clinical features and invites a higher clinical attention and perspectival monitoring. Some findings suggest that more fine-grained psychopathological distinctions might be a viable clinical and research strategy to advance the field in the direction of precision psychiatry.

Concurrent Obsessive-Compulsive Symptoms in Patients With Schizophrenia: A Retrospective Study From a Tertiary Care Centre in Sindh, Pakistan

INTRODUCTION

The present study aimed to evaluate the proportion of concurrent symptoms of obsessive-compulsive symptoms (OCSs) among patients with schizophrenia.

METHODS

A retrospective study was undertaken at the Department of Psychiatry, Jinnah Postgraduate Medical Center, Sindh, Pakistan between 1st March 2019 and 1st April 2020. All cases with diagnosed schizophrenia irrespective of gender, age, or ethnicity were eligible for the study. We excluded patients with acute psychosis due to isolated substance use disorder or any organic brain disease. The medical records for each patient were retrieved from the departmental database. Sociodemographic factors including age, gender, ethnicity, and presence of OCSs and other psychiatric comorbidities were recorded in a predefined pro forma. The presence of OCSs was noted by the attending psychiatrist during history taking as positive or negative.

RESULTS

A total of 139 patients were included. A predominance of the male gender was noted. There were 63 (45.3%) patients with concurrent OCSs. Out of the total patients, 42 (66.67%) males and 21 (33.33%) females had OCSs. A total of 28 (44.44%) patients between 31 and 45 years of age had OCSs. Out of the 63 patients with OCSs, 36 (57.14%) had a history of substance abuse (p = 0.471). In the study, 17 (26.98%) Balochi and 19 (30.16%) Pashtuns had OCSs. However, the difference was statistically insignificant.

CONCLUSION

In conclusion, OCSs were frequent in patients with schizophrenia, according to the current study. We discovered that males, individuals between the ages of 18 and 30 years, Balochis, Pashtuns, and those with a history of substance abuse were more likely to have OCSs. However, the difference was not statistically significant.

Drawing the Line Between Obsessive-Compulsive Disorder and Schizophrenia

The schizo-obsessive spectrum has been a central focus of interest and research within the scientific community in mental health. The increased comorbidity of schizophrenia and obsessive-compulsive symptoms (OCS) or obsessive-compulsive disorder (OCD) appears to be considerably higher than previously expected, with more recent studies suggesting growing prevalence rates. Despite this phenomenon, OCS are not considered primary manifestations of schizophrenia and are therefore not usually explored in these patients. The concept of schizo-obsessiveness mostly emerged in the 1990s, progressing into OCD-schizophrenia spectrum disorders as a dual diagnosis of OCD and schizophrenia. The manifestations of the schizo-obsessive spectrum are diverse, and its diagnoses may be divided overall into four main categories: schizophrenia with OCS; schizotypal personality disorder (SPD) with OCD; OCD with poor insight; schizo-obsessive disorder (SOD). In some cases, distinguishing an intrusive thought from delirium in OCD with poor insight might be challenging. Poor or absent insight can be present in many diagnoses of OCD. Those patients within the schizo-obsessive spectrum present a worse insight than those with OCD without schizophrenia. The comorbidity has important clinical implications, considering its association with an earlier onset of the disorder, more severe positive and negative psychotic symptoms, a greater cognitive deficit, more severe depressive symptoms, more suicide attempts, a reduced social network, increased psychosocial dysfunction, and consequently a worse quality of life and greater psychological suffering. The presence of OCS or OCD in schizophrenia may lead to more severe psychopathology and a worse prognosis. More precise diagnoses allow for a more targeted intervention by offering an optimized psychotherapeutic and psychopharmacological approach. We hereby present four clinical cases that represent each of the four designated categories of the schizo-obsessive spectrum. This case-series report aims to enhance clinical insight regarding the diversity of the schizo-obsessive spectrum and to illustrate the difficult and sometimes misleading process of differentiating OCD from schizophrenia and establishing a diagnosis due to the potential overlap of phenomenology, as well as the course and assessment of symptoms manifested within the spectrum.

Association between obsessive-compulsive disorder and the risk of schizophrenia using the Korean National Health Insurance Service-National Sample Cohort: a retrospective cohort study

AIMS

Obsessive-compulsive disorder (OCD) and schizophrenia are often reported as co-morbid conditions. However, the evidence of an association between OCD and the risk of schizophrenia is limited. This study investigated the risk of schizophrenia in patients newly diagnosed with OCD using a nationally representative sample cohort in South Korea.

METHODS

Data were obtained from the 2002-2013 Korean National Health Insurance Service-National Sample Cohort of the National Health Insurance Service. Using propensity score matching, 2509 patients with OCD and a control group of 7527 patients were included in the analysis. Chi-squared tests were used to investigate and compare the general characteristics of the study population. The risk of schizophrenia was analysed using the Cox proportional hazard model.

RESULTS

The incidence rate was 45.79/10 000 person-year for patients with OCD and 4.19/10 000 person-year for patients without OCD. Patients with OCD had a higher risk of schizophrenia compared to the control group after adjusting for covariates (hazard ratio = 10.46, 95% confidence interval = 6.07-18.00).

CONCLUSIONS

This study identified an association between the diagnosis of OCD and the risk of schizophrenia in a South Korean national representative cohort. Further research using a prospective design to clarify the causality of OCD in schizophrenia in a controlled environment should be conducted to validate these findings.

Disclosing common biological signatures and predicting new therapeutic targets in schizophrenia and obsessive-compulsive disorder by integrated bioinformatics analysis

Schizophrenia (SCZ) is a severe mental illness mainly characterized by a number of psychiatric symptoms. Obsessive-compulsive disorder (OCD) is a long-lasting and devastating mental disorder. SCZ has high co-occurrence with OCD resulting in the emergence of a concept entitled "schizo-obsessive disorder" as a new specific clinical entity with more severe psychiatric symptoms. Many studies have been done on SCZ and OCD, but the common pathogenesis between them is not clear yet. Therefore, this study aimed to identify shared genetic basis, potential biomarkers and therapeutic targets between these two disorders. Gene sets were extracted from the Geneweaver and Harmonizome databases for each disorder. Interestingly, the combination of both sets revealed 89 common genes between SCZ and OCD, the most important of which were BDNF, SLC6A4, GAD1, HTR2A, GRIN2B, DRD2, SLC6A3, COMT, TH and DLG4. Then, we conducted a comprehensive bioinformatics analysis of the common genes. Receptor activity as the molecular functions, neuron projection and synapse as the cellular components as well as serotonergic synapse, dopaminergic synapse and alcoholism as the pathways were the most significant commonalities in enrichment analyses. In addition, transcription factor (TFs) analysis predicted significant TFs such as HMGA1, MAPK14, HINFP and TEAD2. Hsa-miR-3121-3p and hsa-miR-495-3p were the most important microRNAs (miRNAs) associated with both disorders. Finally, our study predicted 19 existing drugs (importantly, Haloperidol, Fluoxetine and Melatonin) that may have a potential influence on this co-occurrence. To summarize, this study may help us to better understand and handle the co-occurrence of SCZ and OCD by identifying potential biomarkers and therapeutic targets.

[Obsessive-compulsive symptoms in psychotic disorders: pathogenesis and treatment]

BACKGROUND

Comorbid disorders often occur in psychoses from the schizophrenia spectrum and are an additional burden for patients' quality of life, render treatment and rehabilitation prognosis more difficult and can also contribute to suicidal ideation. Specifically, obsessive-compulsive syndrome (OCS) and OC disorder (OCD) have been reported.

OBJECTIVE

What is known about the epidemiology and pathogenesis and which conclusions can be drawn regarding the diagnostics and treatment?

MATERIAL AND METHODS

This review evaluated current reports on comorbid OCS during different stages of psychotic disorders, starting with the at-risk mental state (ARMS) via the first manifestation and up to chronic courses. The focus was on pharmacological and psychotherapeutic consequences.

RESULTS

Patients with ARMS suffer much more often from OCS than the general population. The prevalence is even higher in patients with a first manifestation of psychosis. During the chronic courses ca. 30% of patients are affected by comorbid OCS and 12% fulfill the diagnostic criteria of a OCD. The pathogenesis can most likely be explained by a genetic disposition in the glutamatergic system, shared structural and functional abnormalities of cortical and subcortical structures, pharmacological influences and psychosocial stressors.

CONCLUSION

Clozapine and other antipsychotics may induce or aggravate OCS in a dose-dependent manner. In order to alleviate symptoms clozapine should be reduced to a minimally sufficient level. This can be attempted through combination, for example with dopaminergic antipsychotics. In general, serotonergic antidepressants can be added. Cognitive behavioral therapy should be offered to every patient with comorbid OCS. For future research multimodal longitudinal studies investigating the efficacy of interventions and aimed at the subjective level will be important.

Diagnostic progression to schizophrenia in 35,255 patients with obsessive-compulsive disorder: a longitudinal follow-up study

Evidence suggests a continuity between obsessive-compulsive disorder (OCD) and schizophrenia. However, the factors that may predict diagnostic progression from OCD to schizophrenia remain unclear. A total of 35,255 adolescents and adults with OCD (ICD-9-CM code: 300.3) were enrolled between 2001 and 2010 and followed up at the end of 2011 for the identification of de novo schizophrenia (ICD-9-CM code: 295). The Kaplan-Meier method was used to estimate incidence rates, and the Cox regression was used to determine the significance of candidate predictors. At the end of the 11-year follow-up period, the crude cumulative progression rate from OCD to schizophrenia was 6%, and the estimated progression rate totaled 7.80%. Male sex (hazard ratio: 1.23), obesity (1.77), autism spectrum disorder (1.69), bipolar disorder (1.69), posttraumatic stress disorder (1.65), cluster A personality disorder (2.50), and a family history of schizophrenia (2.57) also were related to an elevated likelihood of subsequent progression to schizophrenia in patients with OCD. Further study is necessary to elucidate the exact pathomechanisms underlying diagnostic progression to schizophrenia in patients with OCD.

Schizo-obsessive disorder - case study

Introduction: Schizo-obsessive disorder is a term that includes a dual diagnosis: schizophrenia and obsessive-compulsive disorder (OCD). The schizo-obsessive disorder definition was made at the end of the 19th century and is still valid today. Nowadays, the coexistence of schizophrenia with obsessive-compulsive syndromes becomes more commonly observed, therefore the recognition and number of the described cases has increased.

Material and methods: The aim of this article is to present a clinical case of a patient with a diagnostically and therapeutically difficult disorder, including the comorbidity of schizophrenia and OCD. The analysis of the clinical case and the medical records of a patient and a review of the literature including schizophrenia, OCD, and schizo-obsessive disorder, was performed.

Case study: A male patient, 20 years old, single, high school student, who lives with his family. In November 2019 a mental deterioration occurred. Simultaneously, obsessional ideas and behaviors appeared. An ambulatory treatment was introduced, however without adequate response, which was the cause of the first psychiatric hospitalization in 2020.

Discussion: Comorbidity between obsessive-compulsive disorder and schizophrenia may cause a particular problem for physicians. Without appropriate diagnosis, there is no possibility to implement proper management and treatment. Obsessive-compulsive symptoms should be treated as relatively common in patients with schizophrenia, which will prevent a mistake in the assessment of the patient’s condition.

Conclusions: Due to specific character of the disease, difficulties in diagnosis and treatment, there is a special need for individual therapeutic measures. Appropriate and targeted approach to the patient may be a chance for success in therapy.

Through the prism of comorbidity: A strategic rethinking of early intervention in obsessive-compulsive disorder

The diagnostic criteria for obsessive-compulsive disorder (OCD) have undergone minor changes in DSM-5 yet a major turnaround intervened in the overarching categorical allocation. OCD indeed has been separated from the anxiety disorders and included in an autonomous class of OCD-related disorders. Converging factors, i.e., the specificity of the clinical phenotype, the robust evidence for familial aggregation, the availability of effective treatments, and the increasing awareness of the role of environmental factors in its onset and course make OCD a suited target for tailored early intervention programs. However, studies on the topic are still scarce and OCD remains marginally conceptualized within an overdue early detection/intervention framework. Starting from the consolidated clinical evidence of OCD extensive comorbidity with schizophrenia-spectrum and bipolar disorders, we articulate a strategic proposal for a more integral incorporation of OCD within early detection and intervention paradigm.

Recognizing Psychosis in Autism Spectrum Disorder

There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of comorbid psychosis in patients with Autism Spectrum Disorder represents a complex challenge from a psychopathological point of view, in particular in patients with greater deficits in verbal communication. Intercepting the onset of a psychotic breakdown in autism may be very difficult, both disorders in fact occur along a phenotypic continuum of clinical severity and in many cases, psychotic symptoms are present in an attenuated form. In this paper, we reviewed the available scientific literature about comorbidity between psychosis and autism, focusing our attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course. The aim of this paper is to provide clinical tools to identify these psychotic phenomena in autistic patients, even when they occur in their attenuated form.

A nationwide nested case-control study of new-onset obsessive-compulsive disorder following antipsychotics use in schizophrenia

OBJECTIVE

A substantial proportion of patients with schizophrenia suffer from comorbid obsessive-compulsive disorder (OCD) possibly associated with antipsychotics. However, little is known about the comparative risks of the antipsychotics. The present study aimed to investigate the risk of new-onset OCD following the initiation of different antipsychotic medications for schizophrenia relative to haloperidol.

METHODS

Using the Korean national claims data, patients aged 15-60 years newly diagnosed with schizophrenia between 2010 and 2018 were identified. Of the 47,808 patients with schizophrenia treated with nine commonly prescribed antipsychotics, 775 new-onset OCD patients were matched to 3,100 patients without OCD using nested case-control design with 1:4 case-control matching based on the sex, age of index date, date of schizophrenia diagnosis, observation period, locations of medical institutions, and level of medical facilities. Using multivariable conditional logistic regression analysis, odd ratios (ORs) for new-onset OCD comparing each antipsychotic agent relative to haloperidol were computed.

RESULTS

The risk for new-onset OCD during treatment with clozapine was significantly higher than that with haloperidol (adjusted OR 2.86; 95% confidence interval [1.63-5.03]). The risks for new-onset OCD with other antipsychotics were not significantly different from that with haloperidol. In subgroup analysis, the early and intermediate, but not late-onset schizophrenia group showed significant risk for OCD associated with clozapine use.

CONCLUSION

The present findings, based on real-world national representative data, provide reliable evidence for the risk of new-onset OCD in patients with schizophrenia receiving clozapine at a population level.

Comparative Clinical and Neuropsychological Characteristics in Schizophrenia and Schizophrenia-Obsessive-Compulsive Disorder Patients

ABSTRACT

The present study aimed to compare neuropsychological characteristics of patients with schizophrenia and patients with schizophrenia-obsessive-compulsive disorder (OCD). A total of 78 patients were included in the study, with 32 patients diagnosed with schizophrenia and 46 patients diagnosed with schizophrenia-OCD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria. Two groups of the patients were compared with each other in terms of demographic data, psychotic symptoms, and clinical and neuropsychological characteristics. In this study, the schizophrenia-OCD relationship was seen at a higher rate in male patients, and this group has worse clinical features. In addition, there was no significant difference among sociodemographics, clinical characteristics, and social and neuropsychological functionality between the two groups. According to our results, patients with schizophrenia-OCD experience more depression and anxiety that are related to poorer quality of life. Longitudinal and more homogeneous patient groups are needed for further studies to reveal whether schizophrenia accompanied by OCD is a comorbidity, a subtype of schizophrenia, or a different disorder.

Clinical risk factors, phenomenology and the impact of clozapine induced obsessive compulsive symptoms

The aim of this study was to investigate the clinical risk factors, phenomenology and the impact of clozapine induced obsessive-compulsive symptoms (OCS) in patients with schizophrenia. One hundred twenty-two patients receiving clozapine treatment for at least 6 weeks were assessed with Structured Clinical Interview for Axis-I Disorders for DSM-IV, Positive and Negative Syndrome Scale, Yale-Brown Obsessive Compulsive Scale and Checklist, Calgary Depression Scale, Clinical Global Impression Scale and WHO-Disability Assessment Schedule-II. Information about past and current clinical status were gathered through clinical interviews and medical records. With clozapine 44.3% of the patients had de novo OCS, 33.6% had OCS both before and after clozapine, 21.3% didn't report any OCS. Clozapine doses, clozapine and norclozapine plasma levels were not significantly different. Severity of OCS was affected by clozapine and norclozapine plasma levels, and correlated with increased disability. Obsessions were less in clozapine induced OCS group, and compulsions, especially of checking subtypes, were predominant, compared to the group with prior history of OCS, who reported a significant increase in checking compulsion after clozapine treatment. Clozapine induced OCS should be considered during cost/benefit assessment of clozapine treatment, and understanding the risk factors and its different phenomenology may shed light into the underlying mechanisms.

Potential Transdiagnostic Lipid Mediators of Inflammatory Activity in Individuals With Serious Mental Illness

Mental disorders are heterogeneous and psychiatric comorbidities are common. Previous studies have suggested a link between inflammation and mental disorders. This link can manifest as increased levels of proinflammatory mediators in circulation and as signs of neuroinflammation. Furthermore, there is strong evidence that individuals suffering from psychiatric disorders have increased risk of developing metabolic comorbidities. Our group has previously shown that, in a cohort of low-functioning individuals with serious mental disorders, there is increased expression of genes associated with the NLRP3 inflammasome, a known sensor of metabolic perturbations, as well as increased levels of IL-1-family cytokines. In the current study, we set out to explore the interplay between disease-specific changes in lipid metabolism and known markers of inflammation. To this end, we performed mass spectrometry-based lipidomic analysis of plasma samples from low-functioning individuals with serious mental disorders (n = 39) and matched healthy controls (n = 39). By identifying non-spurious immune-lipid associations, we derived a partial correlation network of inflammatory markers and molecular lipids. We identified levels of lipids as being altered between individuals with serious mental disorders and controls, showing associations between lipids and inflammatory mediators, e.g., osteopontin and IL-1 receptor antagonist. These results indicate that, in low-functioning individuals with serious mental disorders, changes in specific lipids associate with immune mediators that are known to affect neuroinflammatory diseases.

An Obsessive-Compulsive Symptom-Related Headache in a Patient with Schizophrenia

Obsessive-compulsive symptoms are prevalent, manifold, and sometimes insidious in patients with schizophrenia. In this case study, we reported an intractable headache that bears a close relationship with obsessive-compulsive symptoms in a schizophrenia patient. In a series of treatments, the headache was miraculously susceptible to haloperidol treatment.

Schizotypal and obsessive-compulsive traits: Co-occurrence rate and relationship with executive function, emotion experience, and emotion expressivity in college students

Empirical findings suggest that there is an overlap between schizophrenia and obsessive-compulsive disorder (OCD). These disorders also have a high comorbidity rate. However, little is known about the impact of co-occurring schizotypal and obsessive-compulsive traits on executive function, emotion experience, and emotion expressivity in the normal population. The present study examined the prevalence of coexisting schizotypal and obsessive-compulsive traits and the relationship between these two traits in a sample of healthy college students. We also conducted a moderation analysis to explore the effect of these two type of traits on executive function, emotion experience, and emotion expressivity. We recruited 3,319 participants to complete the Schizotypal Personality Questionnaire (SPQ) and the Obsessive-Compulsive Inventory - Revised (OCI-R). A subset of them (n = 575) also completed the Chinese versions of the Dysexecutive Questionnaire (DEX), the Temporal Experience of Pleasure Scale (TEPS), and the Emotional Expressivity Scale (EES). We found that the prevalence of co-occurring schizotypal and OCD traits was 3.33%. All the subscales of the SPQ and the OCI-R significantly correlated with each other. Both traits had a negative impact on executive function and emotion expressivity. The interaction between the disorganization dimension of schizotypal traits and OCD traits had a significant effect on executive function, but not emotion experience or emotion expressivity. This study was limited by its cross-sectional design and recruitment of only college students. These findings suggest that there is an approximately 3% rate of co-occurring schizotypal and obsessive-compulsive traits in a healthy college student sample. The interaction between these two types of traits may influence executive function.

Assessment of obsessive-compulsive disorder comorbidity and obsessive-compulsive symptom dimensions in patients with schizophrenia

OBJECTIVES

To assess obsessive-compulsive disorder (OCD) comorbidity and obsessive-compulsive symptom (OCS) dimensions in patients with schizophrenia.

METHODS

This cross-sectional study included 300 patients with schizophrenia who were applied to the to the Outpatient Psychiatry Clinic of Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital,  Ankara, Turkey between July and December 2018. Data collection forms created by researchers were applied to the individuals. Obsessive-compulsive symptom were assessed with the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the Dimensional Obsessive Compulsive Scale (DOCS).

RESULTS

The OCD prevalence was 17% (n=50) in the whole group while 10% (n=24/250) of the patients without OCD had 8-15 points at YBOCS. One-way ANOVA test revealed that the patients with OCD showed more severe positive, negative, and depressive symptoms, and also had lower functionality compared to those without OCD (p less than 0.05). The most severe OCS dimension was unacceptable obsessional thoughts in the patients with OCD and OCS. The severity of unacceptable obsessional thoughts was positively correlated with the depressive symptom severity, and negatively correlated with onset age of OCD and insight level in Pearson correlation analysis.

CONCLUSION

Patients with schizophrenia should be evaluated for presence of the OCS/OCD comorbidity in clinical practice. In addition, dimensional assessment of OCS might provide a different viewpoint on the presence of OCS/OCD in schizophrenia.

Schizo-obsessive disorder and neurosurgery for schizophrenia

Schizophrenia likely represents a cluster of diseases presenting with delusions, hallucinations, disorganised behaviour and disorganised thought. Currently, medical therapy struggles to treat a substantial portion of patients, but with improved stratification of component diseases, it may be possible to better understand and treat schizophrenia. The overlap between schizophrenia, schizo-obsessive disorder and obsessive-compulsive disorder is discussed within the context of a clinical case and neuroimaging data. Furthermore, the use of obsessive-compulsive disorder deep brain stimulation protocols for schizo-obsessive disorder is discussed and may yield an advance in neurosurgical treatment of psychiatric conditions.