Obsessive-Compulsive Disorder with Psychotic Features: Is It a Clinical Entity?

Clinical and neuroradiological differences in obsessive compulsive disorder with and without psychosis

Obsessive-compulsive disorder (OCD) and psychosis frequently co-occur, with several hypotheses proposed to explain the relationship between them, and there is limited information regarding the comorbidity of OCD and psychotic symptoms. Therefore, we aimed to detect the prevalence of psychotic symptoms in OCD patients and analyze the psychopathological and neuroimaging associations using Diffuse Tensor Imaging (DTI) between OCD with and without psychotic symptoms in a subset of these patients. Initially, 100 subjects with OCD were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) and a subset of 60 subjects underwent neuroimaging using DTI. Out of 100 subjects, 39 % were classified as OCD with psychotic features, who differed significantly from non-psychotic OCD on several Y-BOCS, BPRS and DTI (especially volume) domains. Our study suggests several clinical and neuroradiological (using DTI) differences between OCD with and without psychotic features. Clinically, the OCD group with psychotic symptoms had a shorter duration of illness, fewer previous episodes and a poorer level of insight, while on DTI, they had significant reduction in grey matter (GM) volume across several brain regions, and significant reduction in the right hippocampal tract on mean diffusivity (MD).

Obsessive-compulsive symptoms in individuals at clinical high risk for psychosis: A 2-year longitudinal study

Aim - Recent findings suggest that OCS are prevalent in individuals with early psychosis. However, their clinical relevance still needs to be clarified. This research specifically explored OCS in subjects at Clinical High Risk for Psychosis (CHRP), with the aims of determining their baseline prevalence, examining their 2-year stability, and analyzing their association with sociodemographic data, clinical characteristics and outcomes. Methods - Clinical assessments at baseline and during the 2-year follow-up period included: the Comprehensive Assessment of At-Risk Mental states (CAARMS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). OCS were identified using the CAARMS item 7.6 subscore. Results - Among 180 CHR-P participants, 66 (36.7 %) had OCS at baseline. CHR-P with OCS had higher PANSS scores and greater antidepressant prescription rates. OCS severity levels improved in the first year, but plateaued over two years, correlating with longitudinal changes in GAF and PANSS total scores. OCS improvement was specifically associated with antidepressant use and intensity of individual psychotherapy sessions. CHR-P subjects with OCS had higher service engagement rates. Conclusions - The presence of OCS could characterize a distinct CHR-P subtype with specific clinical and prognostic characteristics, requiring tailored diagnostic and therapeutic approaches. Recognizing the heterogeneity in CHR-P population is crucial for optimizing care.

Dysconnectivity of the Nucleus Accumbens and Amygdala in Youths with Thought Problems: A Dimensional Approach

Background: Youths with thought problems (TP) are at risk to develop psychosis and obsessive-compulsive disorder (OCD). Yet, the pathophysiological mechanisms underpinning TP are still unclear. Functional magnetic resonance imaging (fMRI) studies have shown that striatal and limbic alterations are associated with psychosis-like and obsessive-like symptoms in individuals at clinical risk for psychosis, schizophrenia, and OCD. More specifically, nucleus accumbens (NAcc) and amygdala are mainly involved in these associations. The current study aims to investigate the neural correlates of TP in youth populations using a dimensional approach and explore potential cognitive functions and neurotransmitters associated with it. Methods: Seed-to-voxels functional connectivity analyses using NAcc and amygdala as regions-of-interest were conducted with resting-state fMRI data obtained from 1360 young individuals, and potential confounders related to TP such as anxiety and cognitive functions were included as covariates in multiple regression analyses. Replicability was tested in using an adult cohort. In addition, functional decoding and neurochemical correlation analyses were performed to identify the associated cognitive functions and neurotransmitters. Results: The altered functional connectivities between the right NAcc and posterior parahippocampal gyrus, between the right amygdala and lateral prefrontal cortex, and between the left amygdala and the secondary visual area were the best predictors of TP in multiple regression model. These functional connections are mainly involved in social cognition and reward processing. Conclusions: The results show that alterations in the functional connectivity of the NAcc and the amygdala in neural pathways involved in social cognition and reward processing are associated with severity of TP in youths.