Obsessive-compulsive symptoms in the schizophrenia-spectrum: current developments in psychopathology research

Abstract

Purpose of reviewSchizophrenia-spectrum disorders (SSD) frequently involve symptoms that usually are ascribed to nonpsychotic disorder spectra, such as obsessive-compulsive symptoms (OCS). These symptoms can cause differential diagnostic challenges, particularly in early illness stages, and must be considered in treatment planning. In this review, we provide an overview of recent literature within the field of OCS in SSD, with a focus on psychopathology research.Recent findingsOCS are seen in approximately a quarter of patients with SSD or at-risk mental state of psychosis. They are associated with more severe clinical features and specific temporal patterns of OCS may be linked with different clinical trajectories. However, the current definitions of OCS have been criticized for their overinclusive nature, which is a limiting step for differential diagnosis and more precise prognostic stratification. Specific phenomenological features, including a link with experiential anomalies (disorders of basic self), have been suggested to provide clinically relevant distinctions.SummaryThe presence of OCS in SSD is associated with more severe clinical features and invites a higher clinical attention and perspectival monitoring. Some findings suggest that more fine-grained psychopathological distinctions might be a viable clinical and research strategy to advance the field in the direction of precision psychiatry.

The Relationship between Childhood Trauma Experiences and Psychotic Vulnerability in Obsessive Compulsive Disorder: An Italian Cross-Sectional Study

“…In fact, OCD and SSD are characterized by apparently overlapping clinical characteristics (i.e., sense of intrusive and recurrent unpleasant thoughts), which are actually underpinned by different phenomenological experiences. In fact, the experiential "mineness" of intrusive thoughts (i.e., whether they are perceived as belonging to the self or not) [1,2] is preserved in people with OCD, while it is questioned in people with SSDs due to a weakening of the primitive feeling that one's own thoughts are self-generated [3,4]. Furthermore, the two disorders present high rates of comorbidity, with prevalence rates around 12% [5], and are overlapping in terms of age of onset and course of illness [6].…”

The Neurobiological Underpinnings of Obsessive-Compulsive Symptoms in Psychosis, Translational Issues for Treatment-Resistant Schizophrenia

“…The presence of OCS in schizophrenia patients could be responsible for making the overall clinical presentation even more complex than schizophrenia and may further worsen the patient’s functioning [ 8 ]. Specific patterns of OCS emergence and duration in schizophrenia may be liable for different clinical trajectories [ 9 ]. Current definitions of OCS have been criticized for their overly inclusive nature, which limits differential diagnosis and more precise prognostic stratification.…”