Schizo-obsessive spectrum disorders: an update

Abstract

The presence of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorders (OCD) in schizophrenia is frequent, and a new clinical entity has been proposed for those who show the dual diagnosis: the schizo-obsessive disorder. This review scrutinizes the literature across the main academic databases, and provides an update on different aspects of schizo-obsessive spectrum disorders, which include schizophrenia, schizotypal personality disorder (SPD) with OCD, OCD with poor insight, schizophrenia with OCS, and schizophrenia with OCD (schizo-obsessive disorder). An epidemiological discussion on the discrepancies observed in the prevalence of OCS and OCD in schizophrenia across time is provided, followed by an overview of the main clinical and phenomenological features of the disorder in comparison to the primary conditions under a spectral perspective. An updated and comparative analysis of the main genetic, neurobiological, neurocognitive, and pharmacological treatment aspects for the schizo-obsessive spectrum is provided, and a discussion on endophenotypic markers is introduced in order to better understand its substrate. There is sufficient evidence in the literature to demonstrate the clinical relevance of the schizo-obsessive spectrum, although little is known about the neurobiology, genetics, and neurocognitive aspects of these groups. The pharmacological treatment of these patients is still challenging, and efforts to search for possible specific endophenotypic markers would open new avenues in the knowledge of schizo-obsessive spectrum.

Increased inflammasome activity in markedly ill psychiatric patients: An explorative study

“…Thus, it is challenging to pinpoint the primary diagnosis and new disorders may emerge over time (Fava et al, 2014). In an attempt to describe these complex conditions, new diagnostic categories, such as schizo-obsessive disorder (Scotti-Muzzi and Saide, 2017) and an autistic subtype of obsessive-compulsive disorder (Bejerot, 2007) have been proposed. Moreover, although non-established diagnoses such as non-suicidal self-injury disorder (Zetterqvist, 2015) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) (Swedo et al, 1998) are recognized as entities in their own right, they are primarily characterized as a comorbidity to another primary disorder.…”

Schizo-obsessive disorder and neurosurgery for schizophrenia

“…The Diagnostic and Statistical Manual of Mental Disorders changes regularly, research in psychiatry is developing at a rapid pace, and the nature of schizo-obsessive disorder makes it difficult to distinguish from similar conditions on the differential diagnosis. Ultimately, there is evidence for the existence of schizo-obsessive disorder as an entity separate from the diagnoses of comorbid schizophrenia with OCD, schizotypal personality disorder with OCD, OCD with poor insight and schizophrenia with antipsychotic-induced compulsive symptoms 8 9. Moreover, the consideration of schizo-obsessive disorder presents a unique opportunity to consider how schizophrenia spectrum disorders may develop unique neuroanatomical pathology.…”

“…Schizophrenia neurosurgery has been underwhelming compared with OCD neurosurgery, but the neuroanatomy and symptomatology in schizo-obsessive disorder may allow effective neurosurgical treatment 16 18. However, no studies have investigated similarities between the nodes typically targeted in OCD nor schizophrenia neurosurgery and their nature in schizo-obsessive disorder 9…”

“…Recently work has suggested a subtype of schizophrenia called schizo-obsessive disorder may exist 8 9. This subtype of schizophrenia portends severe psychosis, severe depressive symptoms, more impaired social function and more suicidality.…”

“…Typical symptoms present within the context of prodromal schizophrenia, clozapine use or true schizo-obsessive disorder 8. As has been reviewed by Scotti-Muzzi and Saide, schizo-obsessive disorder has unique structural and functional connectivity compared with schizophrenia, although there are various other regions of similarity 9. These differences are significant enough that functional neuroimaging of the two disorders may be distinguished 78%–91% of the time by robust functional MRI-based classification systems 10 11.…”