Obsessive compulsive symptoms are related to lower quality of life in patients with Schizophrenia

The Neurobiological Underpinnings of Obsessive-Compulsive Symptoms in Psychosis, Translational Issues for Treatment-Resistant Schizophrenia

Almost 25% of schizophrenia patients suffer from obsessive-compulsive symptoms (OCS) considered a transdiagnostic clinical continuum. The presence of symptoms pertaining to both schizophrenia and obsessive-compulsive disorder (OCD) may complicate pharmacological treatment and could contribute to lack or poor response to the therapy. Despite the clinical relevance, no reviews have been recently published on the possible neurobiological underpinnings of this comorbidity, which is still unclear. An integrative view exploring this topic should take into account the following aspects: (i) the implication for glutamate, dopamine, and serotonin neurotransmission as demonstrated by genetic findings; (ii) the growing neuroimaging evidence of the common brain regions and dysfunctional circuits involved in both diseases; (iii) the pharmacological modulation of dopaminergic, serotoninergic, and glutamatergic systems as current therapeutic strategies in schizophrenia OCS; (iv) the recent discovery of midbrain dopamine neurons and dopamine D1- and D2-like receptors as orchestrating hubs in repetitive and psychotic behaviors; (v) the contribution of N-methyl-D-aspartate receptor subunits to both psychosis and OCD neurobiology. Finally, we discuss the potential role of the postsynaptic density as a structural and functional hub for multiple molecular signaling both in schizophrenia and OCD pathophysiology.

A cross sectional study of impact and clinical risk factors of antipsychotic-induced OCD

A large proportion of schizophrenia patients treated with second generation antipsychotics will develop Obsessive Compulsive Disorder (OCD). However, there are few studies about the impact of this comorbidity and who is at higher risk. In this study of clozapine-treated patients, we aimed to determine the impact on outcome of clozapine-induced OCD, as well as the clinical and sociodemographic risk factors related to OCD-onset in clozapine patients. We had strict and novel inclusion criteria to minimise mis-identification of cases. The Obsessive-Compulsive Inventory-Revised (OCI-R) was used to divide 231 clozapine-treated patients into extreme cases of OCD (OCI  ≥ 24 or checking subscale ≥6) versus non-OCD (OCI <15 and checking subscale <4). The Global Assessment of Functioning (GAF), short version of Warwick-Edinburgh Wellbeing scale and Clinical Global Impression for schizophrenia (CGI) scales were used to determine outcome. Socio-demographic information was used to identify the risk factors for OCD development. We found that schizophrenia patients with OCD symptoms had a significantly lower patient rated wellbeing scores (p < 0.001) only (no difference in clinician rated wellbeing scores), higher CGI positive (p < 0.01) and higher CGI depressive scores (p < 0.05). The only risk factors that reached significance level were higher treatment dose (p < 0.01) and younger paternal age at birth (p < 0.05). There is scope for future studies based on e.g. imaging and genetic studies to further investigate causality, and in improving clinician screening for OCD.

Obsessive-compulsive symptoms in patients with schizophrenia: Relationships with olanzapine pharmacological parameters, psychopathology, and quality of life

Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rated using Yale-Brown Obsessive-Compulsive scale (YBOCS), Positive and Negative Syndrome Scale (PANSS), Montgomery-Åsberg Depression Rating Scale (MADRS), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The concentrations of olanzapine and N-desmethylolanzapine were determined by HPLC. Twenty-five patients (16.6%) revealed the presence of OCS. OCS group had significantly higher olanzapine dose, more numbers of past hospitalizations, higher PANSS total, positive, negative, and general psychopathology scores, and higher MADRS score than those in non-OCS group. The WHOQOL-BREF physical subscale score in schizophrenia patients with OCS was significantly lower. Olanzapine dose, PANSS score, and MADRS score were significantly correlated with YBOCS score. Our findings highlight that OCS is highly prevalent in schizophrenia patients under olanzapine treatment, especially those at high doses. Schizophrenia patients with OCS had higher severity of psychotic and depressive symptoms and poorer quality of life. Clinicians should monitor OCS in patients with schizophrenia receiving olanzapine treatment.

The relationship between obsessive compulsive symptoms and quality of life in Nigerian patients with schizophrenia

BACKGROUND

Obsessive compulsive symptoms (OCS) are relatively common in schizophrenia. Their presence and severity can affect the quality of life (QoL) of schizophrenia patients.

OBJECTIVE

This study aimed to determine the effect of OCS on the subjective QoL of the Nigerian outpatients with schizophrenia. It also determines the sociodemographic and clinical factors associated with OCS.

METHOD

A cross-sectional study involving 232 patients with schizophrenia completed socio-demographic and clinical characteristics questionnaire. OCS was examined with Obsessive Compulsive Inventory (OCI) and QoL was assessed using the brief version of the World Health Organisation Quality of Life questionnaire.

RESULT

Most of the schizophrenia patients with OCS were unmarried, unemployed, had an earlier onset, longer duration of illness, and were on higher doses of antipsychotics. They reported lower QoL and more severity of symptoms of schizophrenia when compared to those without OCS. The OCI total and it's subscales had negative weak to moderate relationship with all the domains of the WHOQoL Bref. Being unemployed, dosage of antipsychotic medication, negative symptoms and OCI total were the predictors of the total quality of life among Nigerian schizophrenia patients.

CONCLUSION

OCS are very common and reduce QoL of schizophrenia patients. Hence, there is a need to routinely screen patients with schizophrenia for OCS and manage them appropriately.

Relationship of obsessive-compulsive symptoms to clinical variables and cognitive functions in individuals at ultra high risk for psychosis

Few studies have investigated the relationship between obsessive-compulsive symptoms (OCS) and clinical variables, and cognition in individuals at ultra high-risk (UHR) for psychosis. The aim of this study was to evaluate the frequency of OCS and their relationship with clinical variables and cognitive functions in individuals at UHR. Eighty-four individuals at UHR for psychosis were administered the Brief Psychiatric Rating Scale, the Yale-Brown Obsession Compulsion Symptom Check List and, the Calgary Depression Scale for Schizophrenia. A cognitive test battery was also applied. We compared the clinical, functional, and cognitive parameters of individuals at UHR with and without OCS and healthy controls. Thirty-five percent of the UHR sample had at least two obsessions/compulsions. The duration of subthreshold psychotic symptoms was longer in individuals with OCS. Those who can work/study before first presentation were more frequent in OCS-positive group. CDSS scores were higher in those with OCS. Compared to controls, OCS-negative group's performance was worse in 8 cognitive test items, while OCS-positive group performed worse in only one cognitive test item. Our findings suggest that OCS are common in the UHR group. OCS might be related to higher level of depression, but better work/study performance, and less cognitive deficits in UHR group.

Obsessive-compulsive symptoms interact with disorganization in influencing social functioning in schizophrenia

OBJECTIVE

Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptoms (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.

METHOD

Seventy-five patients affected by schizophrenia were administered the Structured Clinical Interview for DSM-IV Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment. The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high OCS group).

RESULTS

In both groups, the effect of OCS on functioning was not mediated by their effect on positive, negative or disorganization symptoms. Conversely, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at high levels of disorganization.

CONCLUSION

Data suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS.

The impact of obsessive dimension on symptoms and functioning in schizophrenia

Obsessive Compulsive Symptoms (OCS) and Disorder (OCD) occur frequently in patients with schizophrenia. Nevertheless the impact of OCS/OCD on clinical characteristics and outcome of schizophrenia remains controversial. The aim of the present study is to examine the effect of obsessive-compulsive dimension on symptom expression and functioning in schizophrenia. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale, the Social and Occupational Functioning Assessment Scale and the Strauss and Carpenter Level of Functioning Rating Scale. Obsessive-compulsive dimension was associated neither with positive or disorganization symptoms nor with negative symptoms. By contrast, it adversely affected levels of functioning, with a major impact exerted by compulsions rather than obsessions. Obsessive-compulsive dimension appears to be independent from negative and positive symptoms of schizophrenia and independently decreases social functioning.

Augmentation with antidepressants in schizophrenia treatment: benefit or risk

We focused on the application of antidepressants in schizophrenia treatment in this review. Augmentation of antidepressants with antipsychotics is a common clinical practice to treat resistant symptoms in schizophrenia, including depressive symptoms, negative symptoms, comorbid obsessive-compulsive symptoms, and other psychotic manifestations. However, recent systematic review of the clinical effects of antidepressants is lacking. In this review, we have selected and summarized current literature on the use of antidepressants in patients with schizophrenia; the patterns of use and effectiveness, as well as risks and drug-drug interactions of this clinical practice are discussed in detail, with particular emphasis on the treatment of depressive symptoms in schizophrenia.