Schizophrenia With Obsessive-Compulsive Features
Schizophrenia With Obsessive-Compulsive Features
Obsessive-compulsive (OC) phenomena in patients with schizophrenia have been described for more than a century but have received little systematic study. Previously, OC phenomena were believed to be rare in patients with schizophrenia and were thought to signify a more benign clinical course. Recent studies, however, suggest a greater comorbid prevalence rate and worse outcome among OC schizophrenics. Furthermore, increasing evidence for a neurobiologic basis of both obsessive-compulsive disorder (OCD) and schizophrenia supports the coexistence of these 2 disorders in a subgroup of schizophrenics. Our experience suggests that this subgroup of schizophrenics suffers from a poorer clinical course and greater neuropsychologic impairment. In addition, these patients may show a wide range of treatment response to adjunctive OCD treatment.
Obsessive-compulsive (OC) phenomena have been described for more than 100 years in various forms as a part of schizophrenia. The OC symptoms in schizophrenics may take the form of contamination, sexual, religious, aggressive, or somatic themes, with or without accompanying compulsions such as cleaning, checking, hoarding, repeating, or arranging. Early clinicians, including Westphal, Kraepelin, Stengel, and Bleuler, considered such OC phenomena as either a prodrome or an integral part of schizophrenia. Despite this early focus, little attention has been paid to OC phenomena in schizophrenia. Consequently, research regarding the precise psychopathologic and prognostic implications of OC phenomena in schizophrenia, as well as potential underlying neurobiologic mechanisms in this comorbid condition, has been limited.
During the past decade there has been a growing interest in finding more meaningful subtypes of schizophrenia than those described in both the classic and modern nomenclatures (eg, simple, paranoid, disorganized or hebephrenic, and undifferentiated). This search is based on the assumption that schizophrenia is a heterogeneous disorder with diverse underlying neurobiologic mechanisms. The presence of OC phenomena within the schizophrenic syndrome may offer yet another subtyping strategy, with discrete phenomenologic, neurobiologic treatment response and outcome characteristics. Our experience indicates that there may be three groups of OC schizophrenia: (1) OCD progressing to schizophrenia, (2) schizophrenics with new-onset symptoms, and(3) schizophrenics with transient OC symptoms. In this article we will present and discuss the diagnostic and treatment implications of schizophrenics with significant OC symptoms.
Obsessive-compulsive (OC) phenomena in patients with schizophrenia have been described for more than a century but have received little systematic study. Previously, OC phenomena were believed to be rare in patients with schizophrenia and were thought to signify a more benign clinical course. Recent studies, however, suggest a greater comorbid prevalence rate and worse outcome among OC schizophrenics. Furthermore, increasing evidence for a neurobiologic basis of both obsessive-compulsive disorder (OCD) and schizophrenia supports the coexistence of these 2 disorders in a subgroup of schizophrenics. Our experience suggests that this subgroup of schizophrenics suffers from a poorer clinical course and greater neuropsychologic impairment. In addition, these patients may show a wide range of treatment response to adjunctive OCD treatment.
Obsessive-compulsive (OC) phenomena have been described for more than 100 years in various forms as a part of schizophrenia. The OC symptoms in schizophrenics may take the form of contamination, sexual, religious, aggressive, or somatic themes, with or without accompanying compulsions such as cleaning, checking, hoarding, repeating, or arranging. Early clinicians, including Westphal, Kraepelin, Stengel, and Bleuler, considered such OC phenomena as either a prodrome or an integral part of schizophrenia. Despite this early focus, little attention has been paid to OC phenomena in schizophrenia. Consequently, research regarding the precise psychopathologic and prognostic implications of OC phenomena in schizophrenia, as well as potential underlying neurobiologic mechanisms in this comorbid condition, has been limited.
During the past decade there has been a growing interest in finding more meaningful subtypes of schizophrenia than those described in both the classic and modern nomenclatures (eg, simple, paranoid, disorganized or hebephrenic, and undifferentiated). This search is based on the assumption that schizophrenia is a heterogeneous disorder with diverse underlying neurobiologic mechanisms. The presence of OC phenomena within the schizophrenic syndrome may offer yet another subtyping strategy, with discrete phenomenologic, neurobiologic treatment response and outcome characteristics. Our experience indicates that there may be three groups of OC schizophrenia: (1) OCD progressing to schizophrenia, (2) schizophrenics with new-onset symptoms, and(3) schizophrenics with transient OC symptoms. In this article we will present and discuss the diagnostic and treatment implications of schizophrenics with significant OC symptoms.
