Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: Is there evidence for a schizo-obsessive subtype of schizophrenia?

Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: Is there evidence for a schizo-obsessive subtype of schizophrenia?

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J Psychiatry Neurosci 2005;30(3):187-93

Alexandra Bottas, MD; Robert G. Cooke, MD; Margaret A. Richter, MD

Department of Psychiatry, University of Toronto, and Mood and Anxiety Program, Centre for Addiction and Mental Health, Toronto, Ont.

Abstract

Epidemiologic and neurobiologic evidence suggests that patients with comorbid obsessive–compulsive disorder (OCD) and schizophrenia may represent a special category among patients with schizophrenia. Efforts to examine the neurobiology of this group have focused on neuroimaging studies and neuropsychologic testing. Convergent evidence suggests that there may be a specific pattern of neurobiologic dysfunction in this subgroup of patients accounting for symptom co-expression. This review indicates that future studies should distinguish among (1) apparent obsessive–compulsive symptoms (OCS) that occur only in the context of psychosis and that may overlap with psychotic phenomenology, representing a forme fruste of psychosis; (2) OCS occurring only in the prodromal phase of schizophrenia; (3) neuroleptic-induced OCS or OCD; and (4) OCS or frank OCD occurring concurrently with schizophrenia. We examine the evidence for a putative schizo-obsessive disorder and outline suggestions for identifying OCS in the presence of psychosis.

Résumé

Des données probantes épidémiologiques et neurobiologiques indiquent que les patients atteints à la fois d’un trouble obsessionnel compulsif (TOC) et de schizophrénie pourraient constituer une catégorie spéciale parmi les patients schizophrènes. Les efforts déployés pour examiner ce groupe sous une perspective neurobiologique se sont articulés avant tout autour d’études par neuro-imagerie et de tests neuropsychologiques. Des données probantes convergentes indiquent qu’il pourrait y avoir dans ce sous-groupe de patients un dysfonctionnement neurobiologique de tendance spécifique qui expliquerait la co-expression des symptômes. La présente étude indique que les études futures devraient faire une distinction entre : (1) les symptômes obsessionnels compulsifs (SOC) apparents qui surviennent uniquement dans le contexte de la psychose et qui pourraient chevaucher la phénoménologie psychotique, constituant une forme fruste de psychose; (2) les SOC se produisant uniquement au cours de la phase prodromique de la schizophrénie; (3) les SOC ou les TOC causés par des neuroleptiques; (4) les SOC ou les TOC francs se présentant en même temps que la schizophrénie. Nous ex-aminons les données probantes à l’appui d’un trouble schizo-obsessif présumé et présentons des suggestions pour la détermination des SOC dans les cas de psychose.


Medical subject headings: schizophrenia; obsessive–compulsive disorder; psychiatry; neuropsychology; neurobiology; diagnostic imaging; neurotransmitters.

Submitted May 12, 2004; Revised Sept. 7, 2004; Accepted Sept. 16, 2004

Competing interests: None declared for Dr. Bottas. Dr. Cooke has received speaker fees from Wyeth and Janssen. Dr. Richter has received speaker fees from GlaxoSmithKline, Wyeth and Janssen, and travel assistance from GlaxoSmithKline.

Contributors: This review was conceived, designed and written by Dr. Bottas, who was also responsible for data acquisition. Drs. Cooke and Richter participated in critical revision of the article. All authors participated in analysis and interpretation of the data, and gave final approval for the article to be published.

Correspondence to: Dr. Alexandra Bottas, Staff Psychiatrist, Mood and Anxiety Program, Centre for Addiction and Mental Health, 250 College St., Toronto ON M5T 1R8; bottasa@wmhc.ca