Obsessive–compulsive symptoms in psychotic disorders: longitudinal associations of symptom clusters on between- and within-subject levels

Abstract

Obsessive-compulsive symptoms (OCS) are frequently reported in patients with schizophrenia and have been associated with subjective distress and higher impairment. Recent studies suggest fluctuation in co-occurring OCS and associations with the course of psychotic symptoms. Current evidence is limited by few studies with long assessments intervals and a sole focus on between-subject comparisons. The aim of this study was to specifically investigate co-variation of symptom domains over time within individuals. Patients with a psychotic disorder (n = 56) and un-affected siblings (n = 49) completed monthly assessments of clinical and subclinical symptoms over 6 months. Mixed-model multilevel analyses examined the variability and relationship between OCS and positive, negative, and depressive symptoms on the between- and within-subject level. Symptom domains were associated across subjects and assessment times, in patients and siblings, with the strongest association between OCS and (subclinical) positive symptoms. Within-subjects, substantial variability and co-variation of all symptom domains was found. Particularly, between-subject differences in positive symptoms and within-subject change in depressive symptoms predicted subsequent OCS in patients 1 months later. This is the first prospective study disaggregating between and within-subject associations between co-occurring OCS and symptom cluster of psychosis. Differences on these two levels suggest different underlying mechanisms. The association between depressive symptoms and subsequent increase/decrease of OCS within patients may have important treatment implications.

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

“…Importantly, OCS have very different temporal patterns of onset and persistence among patients with schizophrenia [22]. Recently, studies on longitudinal data from the Dutch GROUP study have provided novel results regarding the associations of such trajectories of OCS with psychopathology and other clinical features [18,23,24]. Schirmbeck et al [18] studied 602 patients with a schizophrenia-spectrum psychotic disorder examined at baseline and after 3 years.…”

Phenomenology and genetic moderators of excessive checking after antipsychotic treatment

“…We used the Clinical and Research Database (CRD) for Persistent Schizophrenia under NHS Research Ethics Committee (REC) approvals (ref. 13/EE/0121; 18/EE/0239). This database contains anonymised routine clinical data from the CPFT Clozapine Clinic [25].…”

“…Others argue de novo OCS in schizophrenia to be an antipsychotic-related event [13]. Epidemiologically, de novo OCS are overrepresented in patients treated with clozapine, olanzapine, or risperidone compared with patients prescribed with aripiprazole, amisulpride or haloperidol [11,14,15].…”

Examination of a bifactor model of the Obsessive-Compulsive Inventory- Revised

“…As mentioned above, the OCI-R is commonly used as the screening instrument for OCD in a large number of studies, which assess OCD symptoms and its relation with a wide variety of situations, namely alexithymia (Khosravani et al, 2017), epilepsy (Kilicaslan et al, 2020;Kim et al, 2020), suicidal experiences (Angelakis & Gooding, 2020), sexual functioning (Ghassemzadeh et al, 2017;Raisi et al, 2015), psychotic disorders (Schirmbeck et al, 2019), therapy outcome (Cludius et al, 2020;Külz et al, 2019;van Passel et al, 2016), neuropsychological performance (Winkworth & Thomas, 2019) or brain morphology and neurophysiological correlates of OCD (Hirose et al, 2017;Wagner et al, 2019;Wang et al, 2020;Yagi et al, 2017).…”