October 2001 Obsessive-Compulsive Disorder and Psychosis


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.

References

1. Stengel E. A study of some clinical aspects of the relationship between obsessional neurosis and psychotic reaction types. J Ment Sci 1945;91:166–87.
2. Rosen I. The clinical significance of obsessions in schizophrenia. J Ment Sci 1957;103:773–85.
3. Karno M, Golding JM, Sorensen SB, Burnam MA. The epidemiology of obsessive-compulsive disorder in 5 US communities. Arch Gen Psychiatry 1988;45:1094–99.
4. Eisen JL, Rasmussen SA. Obsessive compulsive disorder with psychotic features. J Clin Psychiatry 1993;54:373–9.
5. McGuffin P, Framer A, Harvey I. A Polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of OPCRIT system. Arch Gen Psychiatry 1991;48:764–70.
6. Insel TR, Akiskal HS. Obsessive-compulsive disorder with psychotic features: a phenomenologic analysis. Am J Psychiatry 1986;143:1527–33.
7. Eisen JL, Beer DA, Pato MT, Venditto TA, Rasmussen SA. Obsessive-compulsive disorder in patients with schizophrenia or schizoaffective disorder. Am J Psychiatry 1997;154:271–3.
8. MacLean PD. Brain evolution relating to family, play, and the separation call. Arch Gen Psychiatry 1985;42:405.
9. Remington G, Adams M. Risperidone and obsessive-compulsive symptoms [letter] J Clin Psychopharmacol 1994;14:358–9.


Clinical Implications

  • Obsessive-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.


    • Limitations

  • 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.

    • 10. Kopala L, Honer WG. Risperidone, serotonergic mechanisms, and obsessive-compulsive symptoms in schizophrenia [letter]. Am J Psychiatry 1994;151:1714–5.
    11. Berman I, Kalinowski A, Berman SM, Lengua J, Green AI. Obsessive and compulsive symptoms in chronic schizophrenia. Comprehensive Psychiatry 1995;36:6–10.
    12. Bermazohn P, Siris S. Comorbidity in schizophrenia. Paper presented at the annual meeting of the American Psychiatric Association; 1995; Miami (FL).
    13. Fenton WS, McGlashan TH. The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry 1986;143:437–41.
    14. Samuel J, Nesdadt G, Wolyniec P, Adler L, Liang KY, Pulver AE. Obsessive-compulsive symptoms in schizophrenia. Schizophr Res 1993;9:139.
    15. Myers JK, Weissman MM, Tischler GL, Holzer LE III, Leaf PJ, Orvaschel H, and others. Six-month prevalence of psychiatric disorders in 3 communities. Arch Gen Psychiatry 1984;41:959–67.

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