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Tonna M, Borrelli DF, Aguglia E, Bucci P, Carpiniello B, Dell’Osso L, Fagiolini A, Meneguzzo P, Monteleone P, Pompili M, Roncone R, Rossi R, Zeppegno P, Marchesi C, Maj M. The relationship between obsessive-compulsive symptoms and real-life functioning in schizophrenia: New insights from the multicenter study of the Italian Network for Research on Psychoses. Eur Psychiatry 2024; 67:e37. [PMID: 38682575 PMCID: PMC11094474 DOI: 10.1192/j.eurpsy.2024.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Although obsessive-compulsive disorder (OCD) is highly prevalent in schizophrenia, its relationship with patients' real-life functioning is still controversial. METHODS The present study aims at investigating the prevalence of OCD in a large cohort of non-preselected schizophrenia patients living in the community and verifying the relationship of OCD, as well as of other psychopathological symptoms, with real-life functioning along a continuum of OCD severity and after controlling for demographic variables. RESULTS A sample of 327 outpatients with schizophrenia was enrolled in the study and collapsed into three subgroups according to OCD severity (subclinical, mild-moderate, severe). A series of structural equation modeling (SEM) was performed to analyze in each subgroup the association of obsessive-compulsive symptoms with real-life functioning, assessed through the Specific Levels of Functioning Scale and the UCSD Performance-Based Skills Assessment. Moreover, latent profile analysis (LPA) was performed to infer latent subpopulations. In the subclinical OCD group, obsessive-compulsive symptoms (OCS) were not associated with functioning, whereas in the mild-moderate OCD group, they showed a positive relationship, particularly in the domains of work and everyday life skills. The paucity of patients with severe OCD did not allow performing SEM analysis in this group. Finally, LPA confirmed a subgroup with mild-moderate OCS and more preserved levels of functioning. CONCLUSIONS These findings hint at a positive association between mild-moderate OCD and real-life functioning in individuals with schizophrenia and encourage a careful assessment of OCD in personalized programs to sustain daily life activities.
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Affiliation(s)
- Matteo Tonna
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | | | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatric Unit, University of Catania, Catania, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Liliana Dell’Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, Division of Psychiatry, University of Siena, Siena, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, Psychiatric Clinic, University of Padua, Padua, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, Psychiatric Unit, University of Parma, Parma, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Ouazzani Housni Touhami Y, Hlal H, Bout A, Najdi A, Aarab C, Rammouz I, Aalouane R. Clinical profile of schizophrenia comorbid with obsessive-compulsive symptoms: A comparative study. L'ENCEPHALE 2023; 49:549-556. [PMID: 36244835 DOI: 10.1016/j.encep.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Y Ouazzani Housni Touhami
- Psychiatry Department, Hassan II University Hospital, Fez, Morocco; Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco.
| | - H Hlal
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed 1st University, Oujda, Morocco
| | - A Bout
- Psychiatry Department, Hassan II University Hospital, Fez, Morocco; Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco
| | - A Najdi
- Department of epidemiology, Public health and Social Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, Morocco
| | - C Aarab
- Psychiatry Department, Hassan II University Hospital, Fez, Morocco; Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco
| | - I Rammouz
- Psychiatry Department, Agadir University Hospital, Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco
| | - R Aalouane
- Psychiatry Department, Hassan II University Hospital, Fez, Morocco; Clinical Neurosciences Laboratory, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University (USMBA), Fez, Morocco
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Borrelli DF, Cervin M, Ottoni R, Marchesi C, Tonna M. Psychotic Vulnerability and its Associations with Clinical Characteristics in Adolescents with Obsessive-Compulsive Disorder. Res Child Adolesc Psychopathol 2023; 51:1535-1548. [PMID: 37256460 DOI: 10.1007/s10802-023-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/01/2023]
Abstract
Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have examined early indicators of psychosis in pediatric OCD. In the present study, 52 youth with a primary diagnosis of OCD (Mage = 15.66 [SD = 2.33], 59.6% girls) were interviewed using the Schizophrenia Proneness Instrument Child and Adolescent version (SPI-CY), which is a comprehensive clinical interview assessing both Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS). Associations between COPER/COGDIS symptoms and demographic and clinical characteristics were examined. Findings showed that COPER or COGDIS symptoms were present in 44% of participants, with no significant difference between girls and boys. Psychotic vulnerability was associated with an earlier age of OCD onset, greater OCD severity, poorer insight, and more contamination/cleaning symptoms. Psychotic vulnerability was also strongly associated with worse psychosocial functioning. Findings suggest that early indicators of psychosis are frequent in pediatric OCD and associated with more severe OCD and poorer functioning. Research examining how psychotic vulnerability is associated with short- and long-term outcomes for youth with OCD is needed.
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Affiliation(s)
- Davide Fausto Borrelli
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma Ospedale Maggiore, Padiglione Braga Viale A. Gramsci 14, Parma, 43126, Italy.
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Sofiavägen 2D, SE-22241, Lund, Sweden
| | - Rebecca Ottoni
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Carlo Marchesi
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma Ospedale Maggiore, Padiglione Braga Viale A. Gramsci 14, Parma, 43126, Italy
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Matteo Tonna
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma Ospedale Maggiore, Padiglione Braga Viale A. Gramsci 14, Parma, 43126, Italy
- Department of Mental Health, Local Health Service, Parma, Italy
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Scala M, Biondi L, Serretti A, Fabbri C. Obsessive-Compulsive, Psychotic, and Autism Dimensions Overlap in Real World: A Case Report. Clin Neuropharmacol 2023; Publish Ahead of Print:00002826-990000000-00054. [PMID: 37367203 DOI: 10.1097/wnf.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Mauro Scala
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Laura Biondi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Cavaco TB, Ribeiro JS. Drawing the Line Between Obsessive-Compulsive Disorder and Schizophrenia. Cureus 2023; 15:e36227. [PMID: 37069876 PMCID: PMC10105491 DOI: 10.7759/cureus.36227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
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.
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Cunill R, Vives L, Pla M, Usall J, Castells X. Relationship between obsessive compulsive symptomatology and severity of psychotic symptoms in schizophrenia: Meta-analysis and meta-regression analysis. Schizophr Res 2023; 251:37-45. [PMID: 36549240 DOI: 10.1016/j.schres.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/13/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Schizophrenia patients often show obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) and their presence has been associated with poorer prognosis. However, the impact of OCS/OCD on psychotic severity remains unclear. The aim of this study is twofold: 1) to investigate the effect of OCS/OCD on the severity of positive, negative, and global psychotic symptoms of schizophrenia patients and 2) to analyze the effect of patient and study-related covariates on moderating this relationship. METHODS A systematic review and meta-analysis (SRMA) of studies comparing the severity of psychotic symptoms among schizophrenia patients with and without OCS/OCD was performed. Standardized mean difference (SMD) was calculated for positive, negative, and global psychotic symptoms. The difference of SMD (Diff SMD) was calculated to analyze the effect of covariates on study outcomes using meta-regression. RESULTS Sixty-seven studies involving 7740 patients were included. Patients with schizophrenia and OCS/OCD showed a slightly higher severity of positive (SMD = 0.17, p value = 0.0089) and global psychotic symptoms (SMD = 0.24, p value = 0.0104) than patients without OCS/OCD but no differences in negative symptoms were found between groups (SMD = 0.11, p value = 0.0367). Only one covariate "proportion of patients without antipsychotics (AP)" was found to modify the effect on psychotic severity (Diff SMD = -0.008, p value = 0.002). CONCLUSIONS Comorbid OCS/OCD in schizophrenia has, at most, a minor impact on psychotic severity. Variability in this effect was considerable and was poorly explained by the covariates analyzed.
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Affiliation(s)
- R Cunill
- Numància-Parc Sanitari Sant Joan de Déu, Barcelona, Catalonia, Spain.
| | - L Vives
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - M Pla
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - J Usall
- MERITT Group, Research Institute Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Catalonia, Spain
| | - X Castells
- Translab Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Catalonia, Spain
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Abstract
The experiential core of the obsessive mind rests on subtle, primary mental phenomena (such as obsessions and so called "sensory phenomena") which precede and trigger behavioral compulsions. Converging evidence supports a possible pathophysiological role for altered corollary discharge (phenotypically expressed in sensorimotor symptoms and contributing to a reduced Sense of Agency [SoA]), in the neurodevelopment of obsessions and "sensory phenomena." In phenomenological terms, "sensory phenomena" may represent the subjective experiential resonance of an individual history of persistent inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate "sensory phenomena" (eg, by increasing the sensory predictability of the surrounding world). Since disturbances of both SoA and Sense of Ownership have been thematized as potential pathogenetic factors in the neurodevelopment of the psychotic mind, a dimensional account of altered sensorimotor prediction may partly explain the affinities (and high comorbidity) between obsessive-compulsive disorder and schizophrenia spectrum disorders.
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Hudak R, Rasmussen A. Obsessive-Compulsive Disorder and Schizophrenia: Conceptualization, Assessment and Cognitive Behavioral Treatment. J Cogn Psychother 2022; 36:247-267. [PMID: 35882538 DOI: 10.1891/jcp-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is little doubt that schizophrenia (SZ) and obsessive-compulsive disorder (OCD) are among the most severe disorders to impact humanity. They are both common, significantly disabling and have the tendency to strike during critical developmental periods in a young person's life. Schizophrenia affects approximately 1% of the global population and OCD has a lifetime prevalence of between 2% and 3% in the general population. The comorbidities in both SZ and OCD are common and frequently diagnosed, and research has generally found that comorbidities are associated with conditions that are more complex to diagnose and treat, and often result in less favorable prognoses. We review the research that has taken place regarding the co-occurrence of SZ and OCD, discuss it's theoretical conceptulization and clinical differentiation and diagnosis. We then propose recommendations for the best practice of cognitive behavioral therapy in this difficult population, as well as areas that need exploration for future research.
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Affiliation(s)
- Robert Hudak
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Amy Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital
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Initial Presentation of OCD and Psychosis in an Adolescent during the COVID-19 Pandemic. Case Rep Psychiatry 2022; 2022:2501926. [PMID: 35465254 PMCID: PMC9033362 DOI: 10.1155/2022/2501926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic is unparalleled in recent history when accounting for the true disease burden and dramatic impact on physical and mental health. Due to its infectious pathology, COVID-19 presents with a variety of symptoms including neuropsychiatric complications. Moreover, factors such as quarantine, social isolation, and fear of illness have negatively impacted the health of non-COVID-19 patients. There has been significant literature reporting new-onset psychiatric illness in all global populations including those without history of psychiatric illness. This report discusses an adolescent male without prior psychiatric history presenting with new onset symptoms of obsessive-compulsive disorder and psychosis in the context of COVID-19. There are considerable reports describing new-onset obsessive-compulsive disorder, albeit conflicting in terms of prevalence and exacerbations in the setting of COVID-19 in both adult and adolescent populations but limited reports of new-onset psychosis in those same populations and setting.
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Diagnostic progression to schizophrenia in 35,255 patients with obsessive-compulsive disorder: a longitudinal follow-up study. Eur Arch Psychiatry Clin Neurosci 2022; 273:541-551. [PMID: 35332401 DOI: 10.1007/s00406-021-01361-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
Abstract
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.
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Ottoni R, Pellegrini C, Mora L, Marchesi C, Tonna M. Psychopathology of insight in obsessive–compulsive disorder. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Preti A, Meneghelli A, Poletti M, Raballo A. Through the prism of comorbidity: A strategic rethinking of early intervention in obsessive-compulsive disorder. Schizophr Res 2022; 239:128-133. [PMID: 34875511 DOI: 10.1016/j.schres.2021.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/09/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy.
| | - Anna Meneghelli
- Programma2000-Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy; Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
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Fu X, Quan W, Liu L, Li T, Dong W, Wang J, Tian J, Yan J, Liao J. Similarities and Differences in Brain Activation Between Patients With Schizophrenia and Obsessive-Compulsive Disorder: A Near-Infrared Spectroscopy Study. Front Psychiatry 2022; 13:853428. [PMID: 35558422 PMCID: PMC9086627 DOI: 10.3389/fpsyt.2022.853428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia (SZ) and obsessive-compulsive disorder (OCD) share several epidemiological and clinical features, but the neurobiological substrates shared by these two diseases remain unclear. This study aimed to explore the similarities and differences in brain function between them using near-infrared spectroscopy (NIRS). Eventually, 130 SZ patients, 70 OCD and 75 normal controls (NCs) were enrolled. A 52-channel NIRS instrument was used to detect the concentration changes in oxygenated hemoglobin ([oxy-Hb]) during the verbal fluency task. Ten regions of interests (ROIs) were defined: the bilateral dorsolateral prefrontal cortex (DLPFC), frontopolar cortex (FPC), orbitofrontal cortex (OFC), inferior prefrontal gyrus (IFG) and temporal gyrus (TG). Through two different analysis strategies based on channels or ROIs, we compared the [oxy-Hb] changes in three groups by one-way analysis of variance (ANOVA) and post-hoc tests. Across 52 channels, compared to the NC group, both SZ and OCD groups exhibited reduced activity in 17 channels, including left FPC, left DLPFC, bilateral OFC, IFG, middle TG, supplementary motor cortex and Broca's area, while SZ showed lower activity in channel 35 (right OFC) than OCD patients. Across all ROIs, compared to the NC group, both SZ and OCD groups showed reduced activity in 7 ROIs, including left FPC, bilateral OFC, IFG and TG, while SZ showed lower activity in the right OFC than OCD group, which were almost consistent with the results based on channels. This study suggests SZ and OCD present with some similar neuropathological changes, while SZ shows more severe impairment in the right OFC than OCD.
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Affiliation(s)
- Xiaoyu Fu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.,Zhongshan Hospital, Fudan University, Xiamen, China
| | - Wenxiang Quan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lijun Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tian Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Wentian Dong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jiuju Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ju Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jun Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jinmin Liao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Agrawal A, Joshi M, Kar SK, Agarwal V. Role of repetitive transcranial magnetic stimulation in management of obsessive-compulsive disorder in patients of schizophrenia. Asian J Psychiatr 2021; 65:102822. [PMID: 34479023 DOI: 10.1016/j.ajp.2021.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Aditya Agrawal
- King George's Medical University, Lucknow, Uttar pradesh, India.
| | - Mohita Joshi
- King George's Medical University, Lucknow, Uttar pradesh, India.
| | - Sujita Kumar Kar
- King George's Medical University, Lucknow, Uttar pradesh, India.
| | - Vivek Agarwal
- King George's Medical University, Lucknow, Uttar pradesh, India.
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Abstract
Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.
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16
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Lee TY, Jung WH, Kwak YB, Yoon YB, Lee J, Kim M, Kim E, Kwon JS. Distinct neural networks associated with obsession and delusion: a connectome-wide association study. Psychol Med 2021; 51:1320-1328. [PMID: 31997729 DOI: 10.1017/s0033291720000057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obsession and delusion are theoretically distinct from each other in terms of reality testing. Despite such phenomenological distinction, no extant studies have examined the identification of common and distinct neural correlates of obsession and delusion by employing biologically grounded methods. Here, we investigated dimensional effects of obsession and delusion spanning across the traditional diagnostic boundaries reflected upon the resting-state functional connectivity (RSFC) using connectome-wide association studies (CWAS). METHODS Our study sample comprised of 96 patients with obsessive-compulsive disorder, 75 patients with schizophrenia, and 65 healthy controls. A connectome-wide analysis was conducted to examine the relationship between obsession and delusion severity and RFSC using multivariate distance-based matrix regression. RESULTS Obsession was associated with the supplementary motor area, precentral gyrus, and superior parietal lobule, while delusion was associated with the precuneus. Follow-up seed-based RSFC and modularity analyses revealed that obsession was related to aberrant inter-network connectivity strength. Additional inter-network analyses demonstrated the association between obsession severity and inter-network connectivity between the frontoparietal control network and the dorsal attention network. CONCLUSIONS Our CWAS study based on the Research Domain Criteria (RDoC) provides novel evidence for the circuit-level functional dysconnectivity associated with obsession and delusion severity across diagnostic boundaries. Further refinement and accumulation of biomarkers from studies embedded within the RDoC framework would provide useful information in treating individuals who have some obsession or delusion symptoms but cannot be identified by the category of clinical symptoms alone.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wi Hoon Jung
- Department of Psychology, Daegu University, Gyeongsan, Republic of Korea
| | - Yoo Bin Kwak
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Youngwoo B Yoon
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
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17
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Abstract
Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms and is normally considered a heterogeneous disorder. Sometimes, OCD seems to be psychotic in nature, being complex in the differentiation between OCD and schizophrenia. This report describes a female adult patient who was diagnosed in her adolescence with schizophrenia due to her complains of "hearing voices "criticizing her. In response to team request for a second evaluation, she was admitted to the acute inpatient service. After a careful reassessment, the core symptom was recognized as obsession, and her diagnosis was revised to OCD; this allowed for a more direct treatment and management, with cognitive-behavior therapy and high doses of selective serotonin reuptake inhibitors, achieving a sustained clinical improvement over 2 years of follow-up. Currently, she is more functional, participates in social activities, and totally recognizes the egodystonic and intrusive thoughts. This case demonstrates the importance of eliciting psychopathology in greater detail for specific diagnosis and treatment decisions, especially in a complex clinical presentation.
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18
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Udo I, McDaniel C, Chima C. Pharmacological management of comorbid obsessive–compulsive disorder and chronic non-affective psychosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThe comorbidity of obsessive–compulsive symptoms (OCS) in the context of schizophrenia is often not recognised by clinicians, and patients may not report these symptoms until they become severe. However, there is a reported prevalence of 10–24% for obsessive–compulsive disorder (OCD) in schizophrenia and related disorders. The onset of OCS/OCD has been noted to occur both before and after the diagnosis of schizophrenia or schizoaffective disorder. It has also been known to occur following commencement of treatment with antipsychotic medications, especially clozapine. Current literature provides limited guidance for treatment. Review of the current evidence supports: addition of selective serotonin reuptake inhibitors (SSRIs) to antipsychotics; addition of aripiprazole, amisulpride or lamotrigine; or reduction in the dosage of clozapine. There is also evidence supporting the addition of cognitive–behavioural therapy and electroconvulsive therapy (ECT). The SSRIs that are evidenced to be useful are fluvoxamine, escitalopram, sertraline and paroxetine. More studies are needed to expand the evidence base. Early targeted interventions are recommended.
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19
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Winter L, Saryyeva A, Schwabe K, Heissler HE, Runge J, Alam M, Heitland I, Kahl KG, Krauss JK. Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up. Neuromodulation 2020; 24:324-330. [PMID: 32667114 DOI: 10.1111/ner.13232] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a severe disabling disease, and around 10% of patients are considered to be treatment-resistant (tr) in spite of guideline-based therapy. Deep brain stimulation (DBS) has been proposed as a promising treatment for patients with trOCD. However, the optimal site for stimulation is still a matter of debate, and clinical long-term follow-up observations including data on quality of life are sparse. We here present six trOCD patients who underwent DBS with electrodes placed in the bed nucleus of the stria terminalis/anterior limb of the internal capsule (BNST/ALIC), followed for four to eight years after lead implantation. MATERIALS AND METHODS In this prospective observational study, six patients (four men, two women) aged 32-51 years and suffering from severe to extreme trOCD underwent DBS of the BNST/ALIC. Symptom severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and quality of life using the World Health Organization Quality of Life assessment scale (WHO-QoL BREF). Follow-up was obtained at least for four years in all patients. RESULTS With chronic DBS for four to eight years, four of the six patients had sustained improvement. Two patients remitted and two patients responded (defined as >35% symptom reduction), while the other two patients were considered nonresponders on long-term. Quality of life markedly improved in remitters and responders. We did not observe peri-interventional side effects or adverse effects of chronic stimulation. CONCLUSIONS Chronic DBS of ALIC provides long-term benefit up to four to eight years in trOCD, although not all patients take profit. Targeting the BNST was not particularly relevant since no patient appeared to benefit from direct stimulation of the BNST. Quality of life improved in DBS responders, documented by improved QoL scores and, even more important, by regaining of autonomy and improving psychosocial functioning.
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Affiliation(s)
- Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Joachim Runge
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Mesbah Alam
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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20
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Assessing The Relationship Between Clinical Characteristics and Obsessive-Compulsive Disorder Comorbidity and Obsessive-Compulsive Symptoms in Patients With Schizophrenia. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.661854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Lavallé L, Bation R, Dondé C, Mondino M, Brunelin J. Dissociable source-monitoring impairments in obsessive-compulsive disorder and schizophrenia. Eur Psychiatry 2020; 63:e54. [PMID: 32406366 PMCID: PMC7355175 DOI: 10.1192/j.eurpsy.2020.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Based on the observed clinical overlap between obsessive-compulsive disorder (OCD) and schizophrenia (SCZ), both conditions may share, at least in part, common cognitive underpinnings. Among the cognitive deficits that could be involved, it has been hypothesized that patients share a failure in their abilities to monitor their own thoughts (source monitoring), leading to confusion between what they actually did or perceived and what they imagined. Although little is known regarding source-monitoring performances in patients with OCD, numerous studies in patients with SCZ have observed a relationship between delusions and/or hallucinations and deficits in both internal source- and reality-monitoring abilities. METHODS The present work compared source-monitoring performances (internal source and reality monitoring) between patients with OCD (n = 32), patients with SCZ (n = 38), and healthy controls (HC; n = 29). RESULTS We observed that patients with OCD and patients with SCZ displayed abnormal internal source-monitoring abilities compared to HC. Only patients with SCZ displayed abnormalities in reality monitoring compared to both patients with OCD and HC. CONCLUSIONS Internal source-monitoring deficits are shared by patients with OCD and SCZ and may contribute to the shared cognitive deficits that lead to obsessions and delusions. In contrast, reality-monitoring performance seems to differentiate patients with OCD from patients with SCZ.
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Affiliation(s)
- Layla Lavallé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Rémy Bation
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France.,Psychiatry Unit, Wertheimer Hospital, CHU, LyonF-69500, France
| | - Clément Dondé
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Marine Mondino
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
| | - Jérome Brunelin
- INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, LyonF-69000, France.,University Lyon 1, VilleurbanneF-69000, France.,Center Hospitalier Le Vinatier, F-69500 Bron, France
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22
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Balducci PM, Menculini G, Raballo A, Attademo L, Bernardini F, Lucarini E, Sciarma T, Moretti P, Quartesan R, Tortorella A. The obsessive-compulsive side of the schizophrenia spectrum: An empirical exploration in newly admitted acute inpatients. Gen Hosp Psychiatry 2020; 64:110-111. [PMID: 31213280 DOI: 10.1016/j.genhosppsych.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Giulia Menculini
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Raballo
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy.
| | | | | | - Emanuela Lucarini
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Tiziana Sciarma
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Patrizia Moretti
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Quartesan
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy
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23
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Rapid improvement of obsessive-compulsive disorder associated with schizophrenia with cariprazine add-on in a subject under paliperidone long-acting injection: a case report. Int Clin Psychopharmacol 2020; 35:113-118. [PMID: 32004167 DOI: 10.1097/yic.0000000000000284] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder is often associated with schizophrenia and may represent a significant challenge in the treatment as this comorbidity may not respond properly to antipsychotic medication and usually require a pharmacological and psychotherapeutic add-on. In the present case report, we present the case of a 26-year-old male blue-collar subject who developed obsessive-compulsive disorder after a year of complete remission of schizophrenia symptoms under paliperidone long-acting injection that rapidly resolved after low-dosage cariprazine add-on. No adverse effects were reported due to cariprazine- paliperidone long-acting injection combination.
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24
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Kokurcan A, Şafak Y. Assessment of obsessive-compulsive disorder comorbidity and obsessive-compulsive symptom dimensions in patients with schizophrenia. Saudi Med J 2020; 41:275-282. [PMID: 32114600 PMCID: PMC7841571 DOI: 10.15537/smj.2020.3.24909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/06/2020] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Ahmet Kokurcan
- Department of Psychiatry, Faculty of Medicine, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey. E-mail.
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25
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Wang YM, Yang ZY, Cai XL, Zhou HY, Zhang RT, Yang HX, Liang YS, Zhu XZ, Madsen KH, Sørensen TA, Møller A, Wang Z, Cheung EFC, Chan RCK. Identifying Schizo-Obsessive Comorbidity by Tract-Based Spatial Statistics and Probabilistic Tractography. Schizophr Bull 2020; 46:442-453. [PMID: 31355879 PMCID: PMC7442329 DOI: 10.1093/schbul/sbz073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A phenomenon in schizophrenia patients that deserves attention is the high comorbidity rate with obsessive-compulsive disorder (OCD). Little is known about the neurobiological basis of schizo-obsessive comorbidity (SOC). We aimed to investigate whether specific changes in white matter exist in patients with SOC and the relationship between such abnormalities and clinical parameters. Twenty-eight patients with SOC, 28 schizophrenia patients, 30 OCD patients, and 30 demographically matched healthy controls were recruited. Using Tract-based Spatial Statistics and Probabilistic Tractography, we examined the pattern of white matter abnormalities in these participants. We also used ANOVA and Support Vector Classification of various white matter indices and structural connection probability to further examine white matter changes among the 4 groups. We found that patients with SOC had decreased fractional anisotropy (FA) and increased radial diffusivity in the right sagittal stratum and the left crescent of the fornix/stria terminalis compared with healthy controls. We also found changed connection probability in the Default Mode Network, the Subcortical Network, the Attention Network, the Task Control Network, the Visual Network, the Somatosensory Network, and the cerebellum in the SOC group compared with the other 3 groups. The classification results further revealed that FA features could differentiate the SOC group from the other 3 groups with an accuracy of .78. These findings highlight the specific white matter abnormalities found in patients with SOC.
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Affiliation(s)
- Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Zhuo-Ya Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xin-Lu Cai
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Yu Zhou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Rui-Ting Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Han-Xue Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Yun-Si Liang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Xiong-Zhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China,Medical Psychological Institute of Central South University, Changsha, Hunan, PR China
| | - Kristoffer Hougaard Madsen
- Sino-Danish Center for Education and Research, Beijing, PR China,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Thomas Alrik Sørensen
- Sino-Danish Center for Education and Research, Beijing, PR China,Centre for Cognitive Neuroscience, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Arne Møller
- Sino-Danish Center for Education and Research, Beijing, PR China,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Zhen Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, PR China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, PR China,Sino-Danish Center for Education and Research, Beijing, PR China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China,To whom correspondence should be addressed: Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, PR China; tel: 86-(0)10-64836274, fax: 86-(0)10-64836274, e-mail:
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26
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Kokurcan A, Nazlı ŞB. Clinical correlates of obsessive-compulsive disorder comorbidity in patients with schizophrenia. Indian J Psychiatry 2020; 62:51-58. [PMID: 32001931 PMCID: PMC6964451 DOI: 10.4103/psychiatry.indianjpsychiatry_268_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/20/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIM The primary aim of this study was to evaluate the clinical correlates of obsessive-compulsive disorder (OCD) comorbidity in patients with schizophrenia. MATERIALS AND METHODS This study included fifty schizophrenia patients with an existing OCD comorbidity and 200 schizophrenia patients who did not have an OCD diagnosis for a lifetime. The participants were administered Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions Severity Scale (CGI-S), Scale for the Assessment of Positive and Negative Symptoms (SAPS/SANS), Calgary Depression Scale for Schizophrenia (CDSS), Yale-Brown Obsessive Compulsive Scale, and Global Assessment of Functioning Scale. RESULTS Patients with OCD comorbidity had higher BPRS, SANS, and CGI-S scores compared to patients without OCD. In addition, patients with OCD showed worse functional impairment; however, sociodemographic variables, SAPS, CDSS, and insight scores did not show a significant difference depending on the presence of OCD. The present study also showed higher negative and depressive symptoms in patients with preexisting OCD compared to those manifesting OCD during the course of schizophrenia. CONCLUSIONS In this study, patients with schizophrenia and OCD comorbidity showed different clinical features compared to those not showing an OCD presence for a lifetime. In this study, positive symptoms were not determinative in the differentiation of patients with and without OCD. It is important to assess OCD symptoms in patients with schizophrenia, and psychosocial therapies should be provided in patients with OCD to improve negative symptoms and functionality. Patients with preexisting OCD displayed more severe symptoms and seemed to require a different clinical approach in treatment.
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Affiliation(s)
- Ahmet Kokurcan
- Department of Psychiatry, Faculty of Medicine, Health Sciences University, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Şerif Bora Nazlı
- Department of Psychiatry, Faculty of Medicine, Health Sciences University, Gülhane Research and Training Hospital, Ankara, Turkey
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27
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Naguy A. Schizo-obsessive disorder: A clinical quagmire! Asian J Psychiatr 2019; 46:9-10. [PMID: 31568982 DOI: 10.1016/j.ajp.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed Naguy
- Kuwait Centre for Mental Health, Jamal Abdul-Nassir St., 21315, shuwaikh, Kuwait.
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28
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Howard C. Schizo-obsessive disorder and neurosurgery for schizophrenia. BMJ Case Rep 2019; 12:12/11/e232462. [PMID: 31780608 DOI: 10.1136/bcr-2019-232462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Calvin Howard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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29
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Increased inflammasome activity in markedly ill psychiatric patients: An explorative study. J Neuroimmunol 2019; 339:577119. [PMID: 31786499 DOI: 10.1016/j.jneuroim.2019.577119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 01/14/2023]
Abstract
The aim of this study was to investigate inflammatory perturbations in 40 patients with severe and complex psychiatric disorders by studying the activity of the NLRP3 inflammasome, with a trans-diagnostic approach. Gene expression of CASP1, NLRP3, PYCARD, IL1B, IL1RN, TNF showed a significant increase in the patient group compared to a matched control group. Plasma levels of IL1Ra, IL-18, TNF, IL-6 and CRP were increased in the patient group. Within the patient group, increased gene expression of inflammatory markers correlated with increased disease severity. The findings support the inflammation hypothesis for markedly ill psychiatric patients across diagnostic groups.
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Banasikowski TJ, Hawken ER. The Bed Nucleus of the Stria Terminalis, Homeostatic Satiety, and Compulsions: What Can We Learn From Polydipsia? Front Behav Neurosci 2019; 13:170. [PMID: 31417376 PMCID: PMC6686835 DOI: 10.3389/fnbeh.2019.00170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
Abstract
A compulsive phenotype characterizes several neuropsychiatric illnesses - including but not limited to - schizophrenia and obsessive compulsive disorder. Because of its perceived etiological heterogeneity, it is challenging to disentangle the specific neurophysiology that precipitates compulsive behaving. Using polydipsia (or non-regulatory water drinking), we describe candidate neural substrates of compulsivity. We further postulate that aberrant neuroplasticity within cortically projecting structures [i.e., the bed nucleus of the stria terminalis (BNST)] and circuits that encode homeostatic emotions (thirst, hunger, satiety, etc.) underlie compulsive drinking. By transducing an inaccurate signal that fails to represent true homeostatic state, cortical structures cannot select appropriate and adaptive actions. Additionally, augmented dopamine (DA) reactivity in striatal projections to and from the frontal cortex contribute to aberrant homeostatic signal propagation that ultimately biases cortex-dependent behavioral selection. Responding becomes rigid and corresponds with both erroneous, inflexible encoding in both bottom-up structures and in top-down pathways. How aberrant neuroplasticity in circuits that encode homeostatic emotion result in the genesis and maintenance of compulsive behaviors needs further investigation.
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Affiliation(s)
- Tomek J Banasikowski
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
| | - Emily R Hawken
- Department of Psychiatry, Queen's University, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada
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Neural dynamics in co-morbid schizophrenia and OCD: A computational approach. J Theor Biol 2019; 473:80-94. [PMID: 30738051 DOI: 10.1016/j.jtbi.2019.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
Abstract
The co-morbidity of obsessive-compulsive disorder (OCD) and schizophrenia is higher than what would be expected by chance and the common underlying neuropathophysiology is not well understood. Repetitive stereotypes and routines can be caused by perseverative thoughts and motor sequences in both of these disorders. We extended a previously published computational model to investigate cortico-striatal network dynamics. Given the considerable overlap in symptom phenomenology and the high degree of co-morbidity between OCD and schizophrenia, we examined the dynamical consequences of functional connectivity variations in the overlapping network. This was achieved by focusing on the emergence of network oscillatory activity and examining parameter sensitivity. Opposing activity levels are present in orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC) in schizophrenia and OCD. We found that with over-compensation of the primary pathology, emergence of the other disorder can occur. The oscillatory behavior is delicately modulated by connections between the OFC/ACC to the ventral and dorsal striatum and by the coupling between the ACC and dorsolateral prefrontal cortex (DLPFC). Modulation on cortical self-inhibition (e.g. serotonin reuptake inhibitor treatment) together with dopaminergic input to the striatum (e.g. anti-dopaminergic medication) has non-trivial complex effects on the network oscillatory behavior, with an optimal modulatory window. Additionally, there are several disruption mechanisms and compensatory processes in the cortico-striato-thalamic network which may contribute to the underlying neuropathophysiology and clinical heterogeneity in schizo-obsessive spectrum disorders. Our mechanistic model predicts that dynamic over-compensation of the primarily occuring neuropathophysiology can lead to the secondary co-morbid disease.
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The effectiveness of high-dose escitalopram in the treatment of patients suffering from schizophrenia with comorbid obsessive-compulsive disorder: an open-label study. Int Clin Psychopharmacol 2019; 34:179-183. [PMID: 31058717 DOI: 10.1097/yic.0000000000000266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Obsessive-compulsive disorder frequently co-occur with schizophrenia causing a significant impairment. There is a paucity of published data on the treatment of such complicated patients. It has been suggested that the combination of antipsychotics and antiobsessive agents is the best treatment for schizophrenia with obsessive-compulsive disorder; however, there is no published data regarding the use of high dose (up to 40 mg/day) escitalopram. This open-label, prospective study was designed to investigate the efficacy, short-term safety and tolerability of escitalopram in doses up to 40 mg in patients with schizophrenia and obsessive-compulsive disorder. Patients were treated with increasing doses of escitalopram for 13 weeks. Thirteen patients (86.67%) completed the study. A significant improvement was observed in the total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores and in the scores of Y-BOCS-Obsession and Y-BOCS-Compulsion subscales. Furthermore, a significant improvement was observed in the total scores of the Positive and Negative Syndrome Scale and Clinical Global Impression-severity scale. Escitalopram, up to 40 mg/day was well tolerated and may be beneficial in the management of patients with schizophrenia and obsessive-compulsive disorder. Further studies are needed to confirm this finding and to assess long-term safety.
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Mitelman SA. Transdiagnostic neuroimaging in psychiatry: A review. Psychiatry Res 2019; 277:23-38. [PMID: 30639090 DOI: 10.1016/j.psychres.2019.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
Abstract
Transdiagnostic approach has a long history in neuroimaging, predating its recent ascendance as a paradigm for new psychiatric nosology. Various psychiatric disorders have been compared for commonalities and differences in neuroanatomical features and activation patterns, with different aims and rationales. This review covers both structural and functional neuroimaging publications with direct comparison of different psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, conduct disorder, anorexia nervosa, and bulimia nervosa. Major findings are systematically presented along with specific rationales for each comparison.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA.
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Perris F, Fabrazzo M, De Santis V, Luciano M, Sampogna G, Fiorillo A, Catapano F. Comorbidity of Obsessive-Compulsive Disorder and Schizotypal Personality Disorder: Clinical Response and Treatment Resistance to Pharmacotherapy in a 3-Year Follow-Up Naturalistic Study. Front Psychiatry 2019; 10:386. [PMID: 31263430 PMCID: PMC6589899 DOI: 10.3389/fpsyt.2019.00386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
The present study aims to analyze the clinical and socio-demographic characteristics of patients with obsessive-compulsive disorder (OCD) in comorbidity with schizotypal personality disorder (SPD), as well as the response rate to pharmacological treatments. OCD+SPD patients had a younger age at onset, a higher probability to have more severe obsessive-compulsive symptoms, a higher rate of schizophrenia spectrum disorders in their first-degree relatives, and a poorer insight compared to OCD patients. During the 3-year follow-up period, these patients showed a lower rate of recovery, thus requiring augmentation with different psychotropic medications, including low doses of antipsychotics. Our findings suggest that the comorbidity of OCD and SPD causes a poor treatment response, and a reduced probability to recover using standard pharmacological treatment strategies. Further investigations are needed to identify alternative strategies, including psychoeducation and cognitive behavioral therapy, to manage such frequent comorbidity in clinical practice.
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Affiliation(s)
- Francesco Perris
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Abstract
OBJECTIVE To review the available literature on obsessive-compulsive symptom (OCS)/obsessive-compulsive disorder (OCD) in patients with schizophrenia. METHODOLOGY Electronic searches were carried out to locate studies reporting various aspects of OCS/OCD in patients with schizophrenia. RESULTS Available evidence suggests that prevalence of OCS/OCD in patients with schizophrenia is much higher than prevalence in general population and it is seen in all the stages of schizophrenia, starting from at risk mental state to chronic/stabilisation/deficit phases. Symptom profile of OCS/OCD in schizophrenia is similar to that seen in patients with OCD only. Presence of OCS/OCD is associated with higher severity of symptoms of schizophrenia and more negative outcome. At present there is very limited data on the efficacy/effectiveness of various pharmacological measures and psychological interventions, for management of OCS/OCD in patients with schizophrenia. There is some evidence pointing towards beneficial effect of certain antipsychotics, antidepressants and cognitive behaviour therapy. Management of OCS/OCD in patients with schizophrenia involves proper assessment. If the OCS/OCD is related to use of particular antipsychotic use, initial attempt must be made to reduce the dose of antipsychotics, however, if this is not effective, than addition of a selective serotonin reuptake inhibitor (SSRIs) must be considered. If the OCS/OCD is not related to the use of antipsychotic medication, than depending up on the severity of psychotic symptoms, addition of SSRIs must be considered. CONCLUSION This review suggests that OCS/OCD is highly prevalent among patients with schizophrenia and there is limited good quality evidence to make any specific recommendations for management.
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Abstract
Shared obsessive-compulsive disorder (S-OCD) has seldom been reported in the literature, whereas shared psychotic disorder has been described since the end of 19th century. The aim of this report was to describe a case of S-OCD in a married couple. A 38-year-old OCD patient, after several pharmacological trials, eventually improved when a combination of escitalopram and risperidone was prescribed. During his symptoms' remission, his wife started developing the same OCD symptoms. She was prescribed escitalopram, but, given her inconsistent compliance, it was difficult to obtain full effectiveness of the pharmacological treatment. The case showed several common features with S-OCD. Obsessions and delusions could be considered as extremes of the same spectrum-an option recognized by the Diagnostic and statistical manual of mental disorders, fifth edition within the "OCD with poor insight" category-and S-OCD could represent the continuum between OCD and psychotic conditions. Additional investigation is required to better understand psychotic and nonpsychotic shared disorders.
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Qin J, Sui J, Ni H, Wang S, Zhang F, Zhou Z, Tian L. The Shared and Distinct White Matter Networks Between Drug-Naive Patients With Obsessive-Compulsive Disorder and Schizophrenia. Front Neurosci 2019; 13:96. [PMID: 30846924 PMCID: PMC6393388 DOI: 10.3389/fnins.2019.00096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) and schizophrenia (SZ) as two severe mental disorders share many clinical symptoms, and have a tight association on the psychopathological level. However, the neurobiological substrates between these two diseases remain unclear. To the best of our knowledge, no study has directly compared OCD with SZ from the perspective of white matter (WM) networks. Methods: Graph theory and network-based statistic methods were applied to diffusion MRI to investigate and compare the WM topological characteristics among 29 drug-naive OCDs, 29 drug-naive SZs, and 65 demographically-matched healthy controls (NC). Results: Compared to NCs, OCDs showed the alterations of nodal efficiency and strength in orbitofrontal (OFG) and middle frontal gyrus (MFG), while SZs exhibited widely-distributed abnormalities involving the OFG, MFG, fusiform gyrus, heschl gyrus, calcarine, lingual gyrus, putamen, and thalamus, and most of these regions also showed a significant difference from OCDs. Moreover, SZs had significantly fewer connections in striatum and visual/auditory cortices than OCDs. The right putamen consistently showed significant differences between both disorders on nodal characteristics and structural connectivity. Conclusions: SZ and OCD present different level of anatomical impairment and some distinct topological patterns, and the former has more serious and more widespread disruptions. The significant differences between both disorders are observed in many regions involving the frontal, temporal, occipital, and subcortical regions. Particularly, putamen may serve as a potential imaging marker to distinguish these two disorders and may be the key difference in their pathological changes.
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Affiliation(s)
- Jiaolong Qin
- The Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jing Sui
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China
| | - Huangjing Ni
- Smart Health Big Data Analysis and Location Services Engineering Lab of Jiangsu Province, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Shuai Wang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Fuquan Zhang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Zhenhe Zhou
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Lin Tian
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
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Schirmbeck F, Konijn M, Hoetjes V, Zink M, de Haan L. Obsessive-compulsive symptoms in psychotic disorders: longitudinal associations of symptom clusters on between- and within-subject levels. Eur Arch Psychiatry Clin Neurosci 2019. [PMID: 29520640 PMCID: PMC6726663 DOI: 10.1007/s00406-018-0884-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Obsessive-compulsive symptoms (OCS) are frequently reported in patients with schizophrenia and have been associated with subjective distress and higher impairment. Recent studies suggest fluctuation in co-occurring OCS and associations with the course of psychotic symptoms. Current evidence is limited by few studies with long assessments intervals and a sole focus on between-subject comparisons. The aim of this study was to specifically investigate co-variation of symptom domains over time within individuals. Patients with a psychotic disorder (n = 56) and un-affected siblings (n = 49) completed monthly assessments of clinical and subclinical symptoms over 6 months. Mixed-model multilevel analyses examined the variability and relationship between OCS and positive, negative, and depressive symptoms on the between- and within-subject level. Symptom domains were associated across subjects and assessment times, in patients and siblings, with the strongest association between OCS and (subclinical) positive symptoms. Within-subjects, substantial variability and co-variation of all symptom domains was found. Particularly, between-subject differences in positive symptoms and within-subject change in depressive symptoms predicted subsequent OCS in patients 1 months later. This is the first prospective study disaggregating between and within-subject associations between co-occurring OCS and symptom cluster of psychosis. Differences on these two levels suggest different underlying mechanisms. The association between depressive symptoms and subsequent increase/decrease of OCS within patients may have important treatment implications.
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Affiliation(s)
- Frederike Schirmbeck
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands. .,Arkin Institute for Mental Health, Amsterdam, The Netherlands.
| | - Max Konijn
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Vera Hoetjes
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands ,Arkin Institute for Mental Health, Amsterdam, The Netherlands
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Hwang M, Sood A, Riaz B, Poyurovsky M. Obsessive-Compulsive Schizophrenia: Clinical andConceptual Perspective. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20181108-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Bener A, Dafeeah EE, Abou-Saleh MT, Bhugra D, Ventriglio A. Schizophrenia and co-morbid obsessive - compulsive disorder: Clinical characteristics. Asian J Psychiatr 2018; 37:80-84. [PMID: 30149285 DOI: 10.1016/j.ajp.2018.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging co-morbid condition. Also, the relationship between SZ and OCD remains unclear. AIM The aim of this study was to describe the co-morbidity of obsessive-compulsive disorder (OCD) among schizophrenia (SZ) patients and compare clinical characteristics of schizophrenia patients with versus without comorbid OCD. SUBJECTS AND METHODS A cohort-study was carried out on 396 patients enrolled between November 2011 to June 2014 at the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without comorbid OCD (SZ-OCD vs SZ). RESULTS 396 subjects were interviewed. Age of SZ-OCD patients was 42.69 ± 14.33 (years old) whereas SZ patients without OCD ranged 41.59 ± 13.59 years old. There were statistically significant differences in clinical characteristics between SZ with and without OCD : age (p = 0.010), BMI (body mass index; p = 0.011), education (p = 0.033), employment (p = 0.019), cigarette smoking (p = 0.039), sheesha smoking (p = 0.008), and prevalence of consanguinity (p = 0.043). In particular, the rate of consanguinity in the current generation was 31.8% [95% CI = 29.1-34.7]. Also, there were statistically significant differences at Hamilton Depression score, General Health Score, Clinical Global Impression- Score, duration of illnesses, and Global Assessment of Functioning (p < 0.001). The results show that anxious, mood and psychotic dimensions rated higher among SZ - OCD ones than SZ only patients. CONCLUSION This study confirms that SZ-OCD is a common co-morbidity and prevalence of SZ OCD is higher among patients reporting a degree of consanguinity. Even if this condition is under-recognized in clinical practice, it may significantly change SZ presentation and outcome since psychopathological dimensions report higher scores in the co-morbidity sample.
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Affiliation(s)
- Abdulbari Bener
- Dept. of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey; Dept. of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK.
| | - Elnour E Dafeeah
- Dept. of Psychiatry, Rumeilah Hospital, Hamad Medical Corporation, Qatar
| | - Mohammed T Abou-Saleh
- Addiction Research Group, Division of Mental Health, St George's University of London, Cranmer Terrace, London, UK
| | - Dinesh Bhugra
- Dept. of Psychiatry, HSPRD, Institute of Psychiatry, King's College London, UK
| | - Antonio Ventriglio
- Dept of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
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Opakunle T, Akinsulore A, Aloba OO, Fatoye FO. Obsessive-compulsive symptoms in schizophrenia: prevalence and associated factors in a Nigerian population. Int J Psychiatry Clin Pract 2017; 21:195-200. [PMID: 28554299 DOI: 10.1080/13651501.2017.1330417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The objectives of this study were to determine the prevalence of obsessive-compulsive symptoms (OCS) among subjects with schizophrenia and also to determine their associated factors. METHODS A cross-sectional study involving 232 patients with schizophrenia were recruited from a teaching hospital in Nigeria. Socio-demographic questionnaire, Obsessive-Compulsive Inventory, Positive and Negative Syndrome Scale and Suicidality module of the MINI International Neuropsychiatric Inventory were administered. RESULTS The prevalence of OCS was 54.3% among patients with schizophrenia, and washing symptom was the most common (51.7%). Patients with schizophrenia that had OCS had more severe psychopathologies and higher levels of suicidality. OCS among patients with schizophrenia were also associated with the use of second-generation antipsychotic medications. CONCLUSIONS OCS are common in schizophrenia. Hence, there is a need for routine screening of patients with schizophrenia for OCS and then, manage them appropriately.
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Affiliation(s)
- Tolulope Opakunle
- a Department of Psychiatry , Ladoke Akintola University of Technology Teaching Hospital , Osogbo , Osun , Nigeria
| | - Adesanmi Akinsulore
- b Department of Mental Health, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Osun , Nigeria
| | - Olutayo O Aloba
- b Department of Mental Health, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Osun , Nigeria
| | - Femi O Fatoye
- b Department of Mental Health, College of Health Sciences , Obafemi Awolowo University , Ile-Ife , Osun , Nigeria
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