Preferential aggregation of obsessive-compulsive spectrum disorders in schizophrenia patients with obsessive-compulsive disorder.
ABSTRACT To validate a complex association between schizophrenia and obsessive-compulsive disorder (OCD).
We used the Structured Clinical Interview for DSM-IV Axis I disorders to compare the rate of OCD spectrum and additional Axis I disorders in 100 patients who met criteria for both schizophrenia and OCD, non-OCD schizophrenia (n = 100), and OCD (n = 35).
There was a robust between-group difference in the number of patients with one or more OCD spectrum disorders (schizo-obsessive n = 30, compared with schizophrenia n = 8; P = 0.001), that is, higher rates of body dysmorphic (8% compared with 0%) and tic (16% compared with 4%) disorders. No difference was revealed in affective, anxiety, and substance use disorders. We found comparable rates of OCD spectrum disorders in the schizo-obsessive and OCD groups (30% and 42.8%, respectively; P = 0.32).
Preferential aggregation of OCD spectrum disorders in the schizo-obsessive group supports this unique clinical association. Whether a schizo-obsessive interface represents comorbidity or a specific subtype of schizophrenia warrants further investigation.
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ABSTRACT: Interest in the neuro-cognitive profile of patients with schizophrenia and co-morbid obsessive compulsive disorder (schizo-OCD) is rising in response to reports of high co-morbidity rates. Whereas schizophrenia has been associated with global impairment in a wide range of neuro-cognitive domains, OCD is associated with specific deficits featuring impaired performance on tasks of motor and cognitive inhibition involving frontostriatal neuro-circuitry. We compared cognitive function using the CANTAB battery in patients with schizo-OCD (n=12) and a schizophrenia group without OCD symptoms (n=16). The groups were matched for IQ, gender, age, medication, and duration of illness. The schizo-OCD patients made significantly more errors on a task of attentional set-shifting (ID-ED set-shift task). By contrast, no significant differences emerged on the Stockings of Cambridge task, the Cambridge Gamble Task or the Affective Go/NoGo tasks. No correlation emerged between ID-ED performance and severity of schizophrenia, OCD or depressive symptoms, consistent with neurocognitive impairment holding trait rather than state-marker status. Schizo-obsessives also exhibited a trend toward more motor tics emphasizing a neurological contribution to the disorder.Conclusion Our findings reveal a more severe attentional set-shifting deficit and neurological abnormality that may be fundamental to the neuro-cognitive profile of schizo-OCD. The clinical implications of these impairments merit further exploration in larger studies.Psychological Medicine 10/2009; 40(6):921-33. · 5.59 Impact Factor
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ABSTRACT: Literature from the turn of the 20th Century to the present suggests that obsessive-compulsive symptoms occur among persons with schizophrenia at rates that far exceed what is found among persons not suffering from psychoses. Less clear, however, is the significance of those symptoms. Are obsessive-compulsive symptoms, for instance, related to other aspects of schizophrenia or do they represent another isolated dimension of distress? To address this issue, a review of studies is presented that explores the relationships between obsessive-compulsive symptoms; positive, negative and depressive symptoms; psychosocial dysfunction; and neurocognitive deficits. Results are interpreted as indicating that obsessive-compulsive symptoms are linked with graver impairments in psychosocial function. Regarding the relationship between obsessive-compulsive symptoms and neurocognition, results from across a broad range of studies are equivocal. A review of studies of pharmacological treatments for obsessive-compulsive symptoms has also failed to produce consistent results. While some agents have been found to lead to improvement in obsessive-compulsive symptoms, other studies suggest that these medications may exacerbate those same symptoms. In general, it appears that, at best, there are currently few effective treatments. Directions for future research are reviewed. Recommendations include the development of tailored psychological and psychopharmacological interventions, and the implementation of longitudinal studies sensitive to the possibility that there are qualitatively distinct groups of patients with schizophrenia and obsessive-compulsive symptoms.Expert Review of Neurotherapeutics 02/2009; 9(1):99-107. · 2.96 Impact Factor
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ABSTRACT: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder affecting approximately 1-3% of the population. OCD is probably an etiologically heterogeneous condition. Individuals with OCD frequently have additional psychiatric disorders concomitantly or at some time during their lifetime. Recently, some authors proposed an OCD sub-classification based on comorbidity. An important issue in assessing comorbidity is the fact that the non-response to treatment often involves the presence of comorbid conditions. Non-responsive patients are more likely to meet criteria for comorbid axis I or axis II disorders and the presence of a specific comorbid condition could be a distinguishing feature in OCD, with influence on the treatment adequacy and outcome.Frontiers in Psychiatry 01/2011; 2:70.