Obsessive - Compulsive Disorder as a Part of Prodromal Schizophrenia

Abstract

55Prodromal schizophrenia is the initial phase of disturbance prior to the full-blown psychotic picture. It comprises of various and non-specific symptoms such as affective changes anxiety symptoms, unusual perceptions, obsessions and odd beliefs. These manifestations may last from few weeks to several years. Approximately 80%-90% of schizophrenic patients experience the prodrome 1 . However, only 30%-40% of people with prodromal stage convert to florid manifestations of schizophrenia 2 . Many studies of prodromal stage schizophrenia confirm the value of early psychosis intervention.The relation between OCD or OCS and schizophrenia is discussed thoroughly across different stages of schizophrenia except for prodromal phase where limited studies were found. The prevalence of this particular association varies largely from 2.7% to 36.9% for OCS and from 1.5 to 30% for OCD 3,4,5 . The studies had conflicting results regarding the possible transition to psychosis among the ultra-high-risk population with positive OCD/OCS versus negative counterparts 6 .The aim of this report is to present a case of OCD with detailed and intrusive mental images, which were resolved with antipsychotic medications. THE CASEA sixteen-year-old male student presented with six months history of recurrent and intrusive images with disturbing/ frightening content associated with fearfulness and decreased socialization. The patient would see himself near a graveyard, trying to run away while being chased by dead people and feeling extremely terrified. These images come episodically daily (4-7 episodes per day) lasting approximately 2-3 minutes Prodromal schizophrenia presents with a wide variety of psychiatric symptoms including obsessive-compulsive disorder (OCD) or obsessive-compulsive symptoms (OCS). However, this differentiation between a sole diagnosis of OCD and prodromal schizophrenia seems challenging in some settings.We present a sixteen-year-old male with six-months history of recurrent intrusive images and fearfulness, in addition to decreased socialization. He was managed as a case of prodromal schizophrenia and was treated with antipsychotics. His obsessions decreased but he continued to exhibit negative schizophrenia within two years of follow-up. Acknowledging the diversity of prodromal schizophrenia presentations rather than treating symptoms as a cross-sectional diagnosis (especially in high-risk population for psychosis) is crucial for a better management.each and had increased in frequency. They were occasionally triggered by seeing his home from outside in a dark and quiet environment.The episodes have the same sequence of images every time. The patient could not stop the flow of images until entering his own home and closing the gate (a relieving ritual) with initial success to abort these intrusive images but failed later. He does not regard these images as irrational. He denied having any other perceptual experiences apart from seeing monsters attacking him, and occasionally an awful girl crawling over the wall shortly be...