Obsessive compulsive symptoms in the psychosis prodrome: Correlates of clinical and functional outcome

Abstract

Objectives Obsessive-Compulsive Disorder (OCD) is a common co-morbid condition in schizophrenia, associated with poor prognosis. However, the prevalence of obsessive compulsive symptomatology (OCS) and its relationship to outcome has not been evaluated in adolescents at ultra high-risk for psychosis (UHR). Methods Sixty-four UHR and 26 non-prodromal comparison (NPC) youth were ascertained using the Structured Interview for Prodromal Syndromes (SIPS). Participants completed diagnostic interviews and the Padua Inventory (Sanavio, 1988), a self-report measure of OCS. Results UHR youth reported significantly higher rates of OCS on the Padua Inventory compared to NPC youth. Clinical diagnosis of OCD (20% of sample) was associated with lower risk of conversion to psychosis over the follow-up period, but was unrelated to clinical severity or psychosocial functioning. However, dimensional ratings of OCS were significantly associated with positive symptom severity, self-reported depression, and a trend toward increased suicidal ideation within the UHR sample. Conclusions OCS rates in UHR youth are well above estimated prevalence rates in normal populations, and commensurate with rates of comorbidity observed in schizophrenia. Although clinical diagnosis of OCD was not associated with later conversion to psychosis, OCS severity in UHR youth was associated with more acute symptomatic presentation, including more severe depression and suicidality.

What drives poor functioning in the at-risk mental state? A systematic review

“…The severity of OC symptoms and degree of functional impairment were not correlated in either sample (Niendam et al, 2009a;Hur et al, 2012). However, seemingly conflicting results were found when patients in these studies were dichotomised into high and low OC symptom groups.…”

“…In addition to clinically diagnosable disorders, this population also report high levels of anxiety symptoms (Niendam et al, 2009a;Chudleigh et al, 2011). In the largest cross-sectional study to date, self-reported anxiety symptoms were found to be modestly correlated with global functioning (measured with the GAF) and a single-item measure of role functioning, but not with more detailed measures including the Global Functioning: Social and Role scales (Fulford et al, 2013).…”

A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

“…Studies have suggested OCD patients bordering on the psychotic may be the group most responsive to antipsychotic augmentation (Rodowski et al, 2008). Furthermore, there is some evidence to suggest that some early cases of schizophrenia-spectrum disorders may initially present with obsessive-compulsive symptoms, and vice versa (Niendam, Berzak, Cannon & Bearden, 2009;Rodowski et al, 2008;Tumkaya et al, 2009). Therefore, this extreme case of OCD may be the precursor to a future psychotic disorder, which may also account for the responsiveness to risperidone.…”

Suicidality in clozapine-treated patients with schizophrenia: Role of obsessive-compulsive symptoms

“…OCD-schizophrenia comorbid patients are more likely to have a previous history of suicidal ideation and attempts. Also, OCS severity is associated with suicidality in adolescents at ultra-high risk for psychosis (Niendam et al, 2009;Sevincok et al, 2007).…”