Obsessive-Compulsive Disorder with Psychotic Features: Is It a Clinical Entity?

Abstract

(1) Background: Even though the comorbidity of obsessive-compulsive disorder (OCD) and a psychotic disorder (PD), such as schizophrenia, is being increasingly recognized, the impact of this comorbidity on the clinical presentation, including insight into obsessive-compulsive symptoms and the functioning of OCD, remains unclear. (2) Methods: To investigate clinical differences between OCD patients with and without PD, 86 Japanese outpatients who met the DSM-IV-TR criteria for OCD were recruited and divided into two groups: 28 OCD patients with PD, and 58 OCD patients without PD. The two groups were cross-sectionally compared in terms of their sociodemographic profiles and clinical characteristics, including the DSM-IV-TR insight specifier and the Global Assessment of Functioning (GAF). (3) Results: The results showed that OCD patients with PD scored lower on both the insight and GAF assessments. (4) Conclusions: The present study suggests that comorbid PD in OCD is a clinical entity.

Psychotic vulnerability and its associations with clinical characteristics in children and adolescents with Obsessive-Compulsive Disorder

“…All three studies indicated elevated levels of psychotic vulnerability and in one study, an association between psychotic vulnerability and impaired global, social, and role functioning was found [37]. A link between psychotic vulnerability and functioning in OCD is consistent with research in adults showing that individuals with both disorders have poorer functioning than those meeting criteria for one of the disorders [2,40], even though mild OCS may play a compensative role in relation to functional impairment due to disorganization symptoms in patients with schizophrenia [4,41].…”

“…The pathophysiological mechanisms underlying the diagnostic progression from OCD to psychosis is still unclear. While the occurrence of OCD/OCS in schizophrenia has been extensively investigated (see summary in Cunill et al 2023) [19], few studies have investigated psychotic vulnerability in patients with a primary diagnosis of OCD, particularly in children and adolescents [20][21][22][23]. This is unfortunate since OCD typically onsets during childhood or adolescence, prior to the onset of schizophrenia [7,8,24], making research on psychotic vulnerability in pediatric OCD highly warranted as it can have both clinical (e.g., early detection) and etiological (e.g., a better understanding of the mechanisms involved in onset and course) implications [25].…”