Lifetime psychopathological characteristics associated with comorbid obsessive-compulsive disorder in clinically stable patients with chronic schizophrenia

Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study

BACKGROUND

Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature.

OBJECTIVE

This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses.

METHODS

We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05.

RESULTS

The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02).

CONCLUSIONS

This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.

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.

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.

Comorbidities within mental illnesses in a multiethnic urban population

The prevalence and patterns of comorbidities among mental illnesses including substance misuse have been rarely documented in urban communities. In this study, we aimed to examine the prevalence, diagnostic patterns, common risk factors and functioning associated with comorbid mental illness among community residents in an urban population. Using data from Singapore Mental Health Study (SMHS) 2010 (n = 6616) and SMHS 2016 (n = 6126), we investigated the changes in the overall prevalence of comorbid mental illness and the diagnostic patterns of multiple affective disorders, affective disorder comorbid with substance misuse and multiple substance misuse. The most common diagnostic pair of comorbid affective disorder was major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) (0.4 % at 2010 and 0.7 % at 2016). Among comorbid substance misuse, comorbidity of MDD and alcohol related disorder (ARD) was most frequent (0.5 % and 0.7 % respectively), while comorbidity of nicotine dependence (ND) with ARD decreased from 0.5 % to 0.1 %. Logistic regression was utilized to identify the associations of socio-demographics/clinical characteristics with patterns of comorbid mental illness and the associations of number of comorbid mental illness with impaired functioning. The risk profileassociated with comorbid mental illnesses differed among various comorbidity groups. Moreover, in SMHS 2016, higher number of comorbidities within mental illness was associated with higher odds of functioning impairment. The increase in the prevalence of comorbid mental illnesses indicates the need for early diagnosis and integrated disease management. Moreover, certain subgroups in the general population are more at risk of comorbid mental illnesses.