These questions need prospective analysis of the phenomenology, course, and outcome of this distinct patient group in large numbers. All patients who improved had received a combination of antiobsessional and antipsychotic drugs; this supports the use
of combination treatment for the patients who have both OC and psychotic symptoms. This fact, however, needs confirmation by prospective study designs. Similarly, in this patient group, other interesting issues, such as the role of risperidone in inducing
or aggravating obsessions and the role of anxiety due to behaviour therapy in worsening the psychotic symptoms, need further exploration.
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Clinical ImplicationsObsessive-compulsive (OC) symptoms may be overlooked in patients who experience persistent psychotic symptoms, in part because severe obsessions and compulsions resemble symptoms of psychosis; hence, they
should be specifically looked for in patients with psychosis.
Combination treatment with antipsychotic and antiobsessional drugs is useful in patients who have both OC and psychotic symptoms.
Risperidone does not appear to increase OC symptoms in patients with obsessive-compulsive disorder (OCD) with psychotic symptoms.
The study design is a retrospective chart review with the attendant limitations of this method.
No standardized scales were employed.
Outcome was measured on a clinical basis.
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