[Frequency of obsessive compulsive symptoms and disorder in patients with schizophrenia: importence for prognosis]

Obsessive-compulsive symptoms in schizophrenia patients and their first-degree relatives and the association with subclinical psychotic symptoms

OBJECTIVE

This study aimed to investigate the presence of obsessive-compulsive symptoms (OCS) in patients being followed for schizophrenia and their first-degree relatives (mother, father, siblings, and children) and the relationship between OCS and clinical/subclinical psychotic symptoms.

MATERIALS AND METHODS

The study included 110 schizophrenia patients followed up in a community mental health center and their first-degree relatives. Patients and relatives were evaluated using the SCID-I (Structured Clinical Interview Form for DSM-IV Axis-I Disorders) to ascertain their diagnosis and exclude other axis-I diagnoses. The Yale-Brown Obsessive Compulsive Scale was used to measure OCS severity. Psychotic symptom severity was evaluated in patients using the Positive and Negative Syndrome Scale (PANSS) and subthreshold psychotic symptoms and psychosis proneness were assessed in relatives using the Schizotypal Personality Questionnaire.

RESULTS

The prevalence of clinically significant OCS was 41.8% in schizophrenia patients and 28.2% in their relatives. PANSS positive and general psychopathology subscale scores were higher in patients with OCS. Suspiciousness and interpersonal schizotypy scores were significantly higher in relatives with OCS compared to those without. The first-degree relatives of patients with OCS did not exhibit a higher prevalence of OCS or psychotic symptoms compared to the relatives of patients without OCS.

CONCLUSION

Our study demonstrates that obsessive-compulsive phenomena are common in schizophrenia patients and their relatives. Although there seems to be a positive association between OCS and psychotic symptoms in patients and their first-degree relatives, the intergenerational transmission of these two symptom groups may occur independently.

Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness

This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.

Prevalence and clinical characteristics of patients with obsessive-compulsive disorder in first-episode psychosis

BACKGROUND

Obsessive-compulsive disorder (OCD) in patients with psychotic disorders has been reported to be a frequent co-morbid disorder in patients with psychotic disorders. The aim of the study determine the prevalence of OCD in first-episode psychosis and the relationship with clinical characteristics.

METHODS

First-episode psychosis patients (N = 246) consecutively admitted to a comprehensive early psychosis program were assessed for OCD with the Structured Clinical Interview for DSM-IV. Symptom assessment measures were the Positive and Negative Syndrome Scale, Global Assessment of Functioning, and the Clinician Rating Scale.

RESULTS

Twenty-six patients (10.6%) fulfilled the criteria for OCD. Patients with comorbid OCD were younger, had more depressive symptoms and a higher rate of suicidal plans or attempts at index point compared to patients without OCD. The two groups did not differ with respect to other demographic variables or severity of psychotic symptoms.

CONCLUSION

OCD is a significant comorbid disorder in patients with first-episode psychosis. Since treatment procedures are different, systematic screening for OCD is warranted.

How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association

OBJECTIVE

The presence of anxiety disorders (AD) in schizophrenia (SZ) is attracting increasing interest. However, published studies have yielded very broad variations in prevalence rates across studies. The current meta-analysis sought to (1) investigate the prevalence of co-occurring AD in SZ by reporting pooled prevalence rates and (2) identify potential sources of variations in reported rates that could guide our efforts to identify and treat these co-occurring disorders in patients with SZ.

METHODS

We performed a systematic search of studies reporting prevalence of AD in SZ and related psychotic disorders. Mean prevalence rates and 95% confidence intervals (CIs) were first computed for each disorder. We then examined the impact of potential moderators related to patient sampling or to AD assessment methods on these rates.

RESULTS

Fifty-two eligible studies were identified. Pooled prevalence rates and CIs were 12.1% (7.0%-17.1%) for obsessive-compulsive disorders, 14.9% (8.1%-21.8%) for social phobia, 10.9% (2.9%-18.8%) for generalized AD, 9.8% (4.3%-15.4%) for panic disorders, and 12.4% (4.0%-20.8%) for post-traumatic stress disorders. For all disorders, we found significant heterogeneity in rates across studies. This heterogeneity could at least partially be explained by the effect of moderator variables related to patient characteristics or assessment methods.

CONCLUSIONS

AD are highly prevalent in SZ, but important variations in rates are observed between studies. This meta-analysis highlights several factors that affect risk for, or detection of AD in SZ, and could, thus, have an important impact on treatment and outcome of SZ patients.

Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications

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.

Broad and narrow personality traits as markers of one-time and repeated suicide attempts: a population-based study

BACKGROUND

Studying personality traits with the potential to differentiate between individuals engaging in suicide attempts of different degrees of severity could help us to understand the processes underlying the link of personality and nonfatal suicidal behaviours and to identify at-risk groups. One approach may be to examine whether narrow, i.e., lower-order personality traits may be more useful than their underlying, broad personality trait dimensions.

METHODS

We investigated qualitative and quantitative differences in broad and narrow personality traits between one-time and repeated suicide attempters in a longitudinal, population-based sample of young French Canadian adults using two multivariate regression models.

RESULTS

One broad (Compulsivity: OR = 2.0; 95% CI 1.2-3.5) and one narrow personality trait (anxiousness: OR = 1.1; 95% CI 1.01-1.1) differentiated between individuals with histories of repeated and one-time suicide attempts. Affective instability [(OR = 1.1; 95% CI 1.04-1.1)] and anxiousness [(OR = .92; 95% CI .88-.95)], on the other hand, differentiated between nonattempters and one-time suicide attempters.

CONCLUSION

Emotional and cognitive dysregulation and associated behavioural manifestations may be associated with suicide attempts of different severity. While findings associated with narrow traits may be easier to interpret and link to existing sociobiological theories, larger effect sizes associated with broad traits such as Compulsivity may be better suited to objectives with a more clinical focus.