Obsessive-compulsive symptoms in major depressive disorder correlate with clinical severity and mixed features

Abstract

Obsessive-compulsive symptoms (OCS) are often reported in patients with bipolar disorder. The aim of this study was to investigate OCS and their related clinical features in major depressive disorder (MDD). The analysis involved 482 outpatients with MDD collected within the Combining Medications to Enhance Depression outcomes trial, who were assessed with scales for depression, suicidality, irritability, hypomanic symptomatology, and other comorbid psychiatric manifestations. OCS were reported in 27% of the sample. Patients with MDD experiencing OCS were found to differ from those not experiencing OCS by a greater severity of depression (d = 0.41, P = 0.0001), more hypomanic symptoms (d = 0.48, P < 0.0001) and mixed features (22% vs. 10%, P = 0.001), increased levels of suicidal thoughts (d = 0.40, P = 0.0001), a lower likelihood of achieving remission after antidepressant treatment (19% vs. 33%, P = 0.0109), as well as more comorbid anxiety disorders (i.e. panic disorder: d = 0.98, P < 0.0001; generalized anxiety disorder: d = 0.74, P < 0.0001; social phobia: d = 0.71, P < 0.0001), and post-traumatic stress disorder (d = 0.81, P < 0.0001). In light of these findings, clinicians should pay more attention to the occurrence of OCS in MDD, as these symptoms may reflect greater clinical severity, poorer treatment outcome, and increased risk for bipolarity.

Obsessive-Compulsive, Psychotic, and Autism Dimensions Overlap in Real World: A Case Report

“…They are associated with higher rates of anxiety and depression, and an increase in hospitalization risk. 27,28 Obsessive-compulsive symptoms are also common features of SPD 29 and result in a worse prognosis in this case as well. [30][31][32] In the case of P, impaired interpersonal relationships were characterized by acute distress, unusual visual perceptual experiences, circumstantial and stereotyped thinking/language, inadequate behavior, and reduced affectivity.…”

“…However, the presence of OC symptoms in patients with schizophrenia is frequent; therefore, some authors have proposed a new clinical entity: the “schizo-obsessive disorder.” 26 In comparison with schizophrenia, in this nosological entity, OC symptoms are typically more severe and manifest at earlier stages of the disease. They are associated with higher rates of anxiety and depression, and an increase in hospitalization risk 27,28 . Obsessive-compulsive symptoms are also common features of SPD 29 and result in a worse prognosis in this case as well 30–32 .…”

Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder

“…Research data were collected by a variety of assessment tools as reported in our previous publications ( Serretti et al , 2021 ; Olgiati and Serretti, 2022a ; Olgiati et al ., 2022 ): (1) a socio-demographic form including age, sex, ethnic group, education and monthly income; (2) the Mini International Neuropsychiatric Interview (MINI) ( Sheehan et al , 1998 ) for diagnostic assessment and to perform a retrospective evaluation of depressive disorder (chronic or recurrent course of depression; number of depressive episodes and age at onset of first episode) and ascertain the lifetime occurrence of subthreshold hypomanic episodes; (3) a battery of scales for cross-sectional clinical assessment including the 30-item Inventory of Depressive Symptomatology-Clinician Rating (IDS-C 30 ) ( Corruble et al ., 1999 ) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-C16) ( Rush et al , 2003 ), the Concise Associated Symptoms Tracking (CAST) for irritability ( Trivedi et al ., 2011b ), the Altman Self-Rating Mania Scale (ASRM) ( Altman, 1998 ) and the Work and Social Adjustment Scale (WSAS) ( Mundt et al , 2002 ) to ascertain functional impairment; (4) the Psychiatric Diagnostic Screening Questionnaire to investigate comorbid mental disorders including panic disorder, generalised anxiety, obsessive-compulsive disorder, social phobia, post-traumatic stress disorder (PTSD) and alcohol and substance use disorders ( Zimmerman and Mattia, 1999 ) and (5) two questionnaires that were specifically developed for the CO-MED project to investigate lifetime suicidal behaviour and experiences of maltreatment during childhood (childhood maltreatment: neglect; emotional abuse; physical abuse and sexual abuse) ( Serretti et al ., 2021 ; Olgiati and Serretti, 2022a ).…”

Persistence of suicidal ideation within acute phase treatment of major depressive disorder: analysis of clinical predictors

“…Research data were collected by a variety of assessment tools as reported in our previous publications (Olgiati et al , 2022; Olgiati and Serretti, 2022; Serretti et al , 2021): (a) a socio-demographic form including age, sex, ethnic group, education and monthly income; (b) the Mini International Neuropsychiatric Interview (M.I.N.I) (Sheehan et al , 1998) for retrospective evaluation of depressive disorder (chronic or recurrent course of depression; number of depressive episodes and age at onset of first episode) and to ascertain the lifetime occurrence of subthreshold hypomanic episodes (see below); (c) a battery of scales for cross-sectional clinical assessment including the 30-item Inventory of Depressive Symptomatology-Clinician Rating (IDS-C 30 ) (Corruble et al , 1999) and the 16-item Quick Inventory of Depressive Symptomatology (Rush et al , 2003), the Concise Associated Symptoms Tracking (CAST) (Trivedi et al , 2011b) for irritability, the Altman Self-Rating Mania Scale (ASRM) (Altman, 1998) and the Work and Social Adjustment Scale (WSAS) (Mundt et al , 2002) to ascertain functional impairment; (d) the Psychiatric Diagnostic Screening Questionnaire (Zimmerman and Mattia, 1999) to investigate comorbid mental disorders including panic disorder, generalised anxiety, obsessive-compulsive disorder, social phobia, posttraumatic stress disorder, and alcohol and substance use disorders; and (e) two questionnaires that were specifically developed for CO-MED project to investigate lifetime suicidal behaviour and experiences of neglect and abuse during childhood (Serretti et al , 2021; Olgiati and Serretti, 2022).…”