A Profile of Obsessive-Compulsive Symptoms In Schizophrenia

AbstractObsessive-compulsive (OC) symptoms and schizophrenia may present, as intertwined phenomena whose relationship remains poorly understood. The purpose of this paper is to provide a detailed phenomenological description of OC symptoms in schizophrenia.Fifty long-term patients with chronic schizophrenia or schizoaffective disorder from a continuing day-treatment program were assessed using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive-Compulsive Scale symptom checklist. Forty-six percent (n=23) reported clinically significant OC symptoms. Twenty-six percent (n=13) met criteria for OCD, from which three subgroups emerged: (1) patients whose OCD was unrelated to their psychotic symptoms, (2) patients whose OCD was related to, but not restricted to, their psychotic symptoms, and (3) patients whose OC symptoms existed on a continuum with their psychosis. The last group tended to incorporate their OC symptoms into delusional beliefs during the active phase of illness and shift to OCD during full or partial remissions. Eight percent met all inclusion criteria for OCD, but their OC symptoms were better accounted for by their psychosis.We conclude that these findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.

Download Full-text

Plasma homovanillic acid, noradrenaline and psychotic symptoms in chronically medicated schizophrenic in patients

Acta Neuropsychiatrica ◽

10.1017/s0924270800040047 ◽

2001 ◽

Vol 13 (2) ◽

pp. 49-52

Author(s):

Y. Kaneda ◽

A. Fujii

Keyword(s):

Informed Consent ◽

Patient Group ◽

Homovanillic Acid ◽

Psychiatric Symptoms ◽

Chronic Schizophrenia ◽

Normal Subjects ◽

Psychotic Symptoms ◽

Neuroleptic Medication ◽

Dsm Iv

SummaryObjective:The authors investigated plasma homovanillic acid (HVA) levels and noradrenaline (NA) in chronically medicated schizophrenic inpatients.Methods:The subjects were 55 inpatients who were diagnosed according to the DSM-IV criteria for schizophrenia. Nine normal subjects were compared to the patient group. Each patient gave informed consent for the research involved in this study. Psychiatric symptoms were assessed using the BPRS.Results:(1) The medicated schizophrenic inpatients had significantly greater plasma NA levels, and higher but nonsignificant plasma HVA levels than the normal subjects.(2) In patients, there was a positive but nonsignificant correlation between the plasma NA levels and positive symptomatology. In contrast, plasma HVA levels were not correlated with either positive or negative symptomatology.Conclusion:On the basis of these results, we hypothesize that, mainly because of their catecholaminergic dysfunction, there is an increase in plasma NA and a tendency for increased plasma HVA in patients with chronic schizophrenia, regardless of long-term neuroleptic medication.

Download Full-text

The health economic implications of treatment with quetiapine: an audit of long-term treatment for patients with chronic schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(01)00583-1 ◽

2001 ◽

Vol 16 (5) ◽

pp. 307-312 ◽

Cited By ~ 10

Author(s):

J. Lynch ◽

J. Morrison ◽

N. Graves ◽

D. Meddis ◽

M.F. Drummond ◽

...

Keyword(s):

Health Economic ◽

Case Series ◽

Chronic Schizophrenia ◽

Term Treatment ◽

Revolving Door ◽

Psychotic Symptoms ◽

Open Label ◽

Economic Implications ◽

Long Term Treatment

SummaryThis retrospective, case series audit assessed the clinical and health-economic impact of long-term treatment with quetiapine (‘Seroquel’), a new atypical antipsychotic, in patients with chronic schizophrenia.The study design was of a case series format, comprising patients entered from one centre into the open-label extension of a multicentre 6-week efficacy study. Twenty-one patients (15 male, six female; mean age 39 years) were studied, of whom 17 (81%) had been rated as ‘partially responsive’ to previous antipsychotics. Data on hospitalisations and information on symptoms were collected retrospectively for the 12 months before quetiapine treatment was initiated and for the 12 months after.Quetiapine was effective in reducing psychotic symptoms with mean BPRS scores reducing significantly, from 38 to 21 (P < 0.005). Motor function was also significantly improved with mean Simpson scale scores reducing from 15 to 12 (P < 0.005). Average inpatient days were reduced by 11% in year two (97 compared with 109 days) while the overall costs of treatment, including drug costs, fell by 5% (I£20,843 to I£19,827).Four patients had been hospitalised for longer than 5 years before starting quetiapine; these chronically institutionalised patients remained in hospital, despite improved clinical outcomes (mean BPRS scores after treatment of 34, compared with 43 before), for the full 12 months of quetiapine treatment. Were the data from this audit to be re-analysed excluding these four patients then average inpatient days would have been reduced by 33% (45 to 30 days) and overall cost of treatment by 19% (I£8617 to I£7011).This audit suggests that treatment with quetiapine over this 1-year period was associated with both clinical improvements and a decreased usage of inpatient services. The reduction in hospitalisation costs would appear to compensate for the increased cost of drug treatment. Significantly, potential savings appear to be greatest for those patients with a ‘revolving door’ pattern of repeated readmission.

Download Full-text

Prevalence of Obesity in Patients Receiving Depot Antipsychotics

The British Journal of Psychiatry ◽

10.1192/bjp.153.2.214 ◽

1988 ◽

Vol 153 (2) ◽

pp. 214-217 ◽

Cited By ~ 70

Author(s):

T. Silverstone ◽

Glenyss Smith ◽

Elizabeth Goodall

Keyword(s):

Antipsychotic Drugs ◽

Clinical Importance ◽

Chronic Schizophrenia ◽

Psychotic Symptoms ◽

Drug Induced ◽

London Borough ◽

Prevalence Of Obesity ◽

Depot Neuroleptic ◽

Depot Antipsychotics

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

Download Full-text

The association of schizophrenia symptoms clusters with obsessive compulsive symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.425 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S385-S386

Author(s):

E. Theochari ◽

E. Tsaltas ◽

D. Kontis

Keyword(s):

Chronic Schizophrenia ◽

Obsessive Compulsive ◽

General Psychopathology ◽

Obsessive Compulsive Symptoms ◽

Syndrome Scale ◽

Competing Interest ◽

Clinically Significant ◽

Psychopathology Symptoms ◽

Relationship Of ◽

The Relationship

IntroductionThirty percent of individuals with schizophrenia demonstrate obsessive compulsive symptoms (OCSs). There is conflicting data on the effects of antipsychotic medication on OCSs in schizophrenia. The delineation of the relationship of OCSs with positive, negative and general psychopathology symptoms has theoretical and treatment implications.ObjectivesTo investigate the relationship among OCSs with the symptoms clusters in schizophrenia.MethodsWe recruited 110 chronic schizophrenia patients and assessed OCSs (Yale-Brown Scale) and schizophrenia symptoms (Positive and Negative Syndrome Scale). In order to investigate the relationship of OCSs with clusters of schizophrenia symptoms, we conducted correlation analyses between YBOCS total scores or obsession or compulsion subscores with the PANSS symptoms scores (total, positive, negative and general psychopathology) and the cognitive scores derived from CANTAB. We re-conducted these correlations for the sub groups with clinically detectable OCSs (YBOCS > 8) and clinically significant OCSs (YBOCS > 14).ResultsThe only significant correlation was that of scores of OCSs with PANSS general psychopathology scores (rho = 0.190, P = 0.047). Obsessions and compulsions did not significantly correlate with positive or negative symptom clusters. No significant correlation between OCSs and schizophrenia symptoms were detected in the subgroups with clinically detectable or significant OCSs.ConclusionsOCSs appear to be a separate symptom cluster in the context of schizophrenia, suggesting that OCSs cannot be expected to be influenced by standard antipsychotic treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia

Psychological Medicine ◽

10.1017/s0033291700035108 ◽

1995 ◽

Vol 25 (4) ◽

pp. 849-857 ◽

Cited By ~ 59

Author(s):

J. L. Waddington ◽

H. A. Youssef ◽

A. Kinsella

Keyword(s):

Prospective Study ◽

Negative Symptoms ◽

Chronic Schizophrenia ◽

Psychotic Symptoms ◽

Neuroleptic Treatment ◽

Cross Sectional ◽

Illness Onset ◽

Clinical Correlate ◽

Sectional Analysis

SYNOPSISCurrent clinical correlates of duration of initially untreated psychotic symptoms were investigated in a cross-sectional analysis followed by a 10-year prospective study among 88 inpatients with a long-standing schizophrenic illness, many of whom had experienced prolonged periods of untreated psychosis due to illness onset and hospital admission in the pre-neuroleptic era. After controlling for the effects of age, and duration and continuity of subsequent neuroleptic treatment, the primary clinical correlate of duration of initially untreated psychosis was muteness. Over the subsequent 10-year-period, no new cases of muteness emerged and some existing cases of muteness partially resolved, though the speech that emerged remained very sparse and revealed generally gross cognitive debility. The pathophysiology underlying active, unchecked psychosis may also constitute an active morbid process that is associated with the further progression of severe negative symptoms and cognitive dysfunction in the long-term.

Download Full-text

Psychotic experiences in patients with obsessive compulsive disorder. A cross sectional clinical study

10.53350/pjmhs211561829 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1829-1833

Author(s):

Mohammad Ali Ghoreishizadeh ◽

Sepideh Herizchi ◽

Sara Farhang

Keyword(s):

Obsessive Compulsive Disorder ◽

Negative Symptoms ◽

Psychotic Symptoms ◽

Psychotic Experiences ◽

Obsessive Compulsive ◽

Cross Sectional ◽

Clinical Interviews ◽

Compulsive Disorder ◽

Dsm Iv ◽

Patients Experience

Background: Obsessive-compulsive disorder (OCD) is associated with heterogeneous and diverse symptoms. A diagnosis is challenging when patients experience psychotic symptoms. This study aimed to evaluate the pattern of psychotic symptoms in patients with OCD. Methods: Using semi-structured clinical interviews, 185 patients meeting the DSM-IV diagnostic criteria for OCD were selected. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Scale for the Assessment of Positive/Negative Symptoms (SAPS/SANS) were used to measure the OCD severity and insight levels and the pattern of psychotic symptoms, respectively. Characteristics of patients with and without psychotic experiences were compared. Results: A total of 38 patients (20.5%) displayed psychotic symptoms. Delusions were observed in 63.2% of these patients, while in 13.2% of them, delusions were accompanied with negative symptoms. Men, those aged between 18 and 34 years, less educated, and singles displayed significantly higher rates of psychotic symptoms. The mean Y-BOCS score (26.42±5.07) was significantly higher in patients with psychotic symptoms than in those without (24.97±6.38). Conclusion: The results showed that in OCD patients, psychotic symptoms are more common in young (<30 years), single, less educated, and those with severe OCD. Keywords: obsessive-compulsive disorder; psychosis; insight.

Download Full-text

Cataract occurrence in patients treated with antipsychotic drugs

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462008000300008 ◽

2008 ◽

Vol 30 (3) ◽

pp. 222-226 ◽

Cited By ~ 16

Author(s):

Valéria Barreto Novais e Souza ◽

Francisco José Rodrigues de Moura Filho ◽

Fábio Gomes de Matos e Souza ◽

Camila Farias Rocha ◽

Fernando Antônio Mendes Lopes Furtado ◽

...

Keyword(s):

Antipsychotic Drugs ◽

Term Therapy ◽

Typical Antipsychotic ◽

Inclusion Criteria ◽

Ocular Side ◽

Dsm Iv ◽

Group 2 ◽

Long Term Therapy ◽

Group 1

OBJECTIVE: Typical antipsychotic drugs, mainly phenothiazines, have been associated with cataract formation for over forty years. Recently, there has been a concern about atypical antipsychotic drugs' potential for inducing this lenticular pathology. Accordingly, we sought to determine the cataract rate and other ocular side effects in patients on long-term therapy with antipsychotic drugs. METHOD: Eighty outpatients with DSM-IV diagnosis of schizophrenia from two settings who met pre determined inclusion criteria were submitted to an ophthalmological evaluation for ocular abnormalities with emphasis in the lens and cornea. They were divided into two groups: group 1 (n = 52) comprised patients who had been predominantly on typical antipsychotics for at least two years and group 2 (n = 28) patients who had been predominantly on atypical antipsychotics for at least two years. RESULTS: Cataract was found in 26 patients (33%) with predominance of anterior capsular cataract. The cataract rate among patients from group 1 (40%) was higher than among those from group 2 (18%). Visual acuity was reduced in 21 patients (26%). No changes were observed neither in the cornea nor in the retina. CONCLUSIONS: Patients using antipsychotic drugs should be submitted to a periodic ophthalmological evaluation.

Download Full-text

Tools & Resources: Impairment and Disability Web Sites

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1999.novdec03 ◽

1999 ◽

Vol 4 (6) ◽

pp. 5-6

Keyword(s):

Personality Disorder ◽

Personality Disorders ◽

Interpersonal Relationships ◽

Web Sites ◽

Outpatient Psychotherapy ◽

Obsessive Compulsive ◽

Not Otherwise Specified ◽

Cluster B Personality Disorders ◽

Clinically Significant ◽

And Behavior

Abstract Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from those expected by the individual's culture; these inflexible and pervasive patterns reflect issues with cognition, affectivity, interpersonal functioning and impulse control, and lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, defines two specific personality disorders, in addition to an eleventh condition, Personality Disorder Not Otherwise Specified. Cluster A personality disorders include paranoid, schizoid, and schizotypal personalities; of these, Paranoid Personality Disorder probably is most common in the legal arena. Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic personality. Such people may suffer from frantic efforts to avoid perceived abandonment, patterns of unstable and intense interpersonal relationships, an identity disturbance, and impulsivity. Legal issues that involve individuals with cluster B personality disorders often involve determination of causation of the person's problems, assessment of claims of harassment, and assessment of the person's fitness for employment. Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive personality. Two case histories illustrate some of the complexities of assessing impairment in workers with personality disorders, including drug abuse, hospitalizations, and inpatient and outpatient psychotherapy.

Download Full-text