Schizophrenia-spectrum psychopathology in obsessive–compulsive disorder: an empirical study

Abstract

The differential diagnosis of obsessive-compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession ('with resistance') and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive-compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.

Associations between Self-Disorders and First-Rank Symptoms: An Empirical Study

“…This seems to corroborate Schneider’s original idea that many FRS involve a loss of the very contours of the self. During the last 2 decades, empirical studies have consistently found self-disorders to be specific for schizophrenia [29, 40, 41]. Our results are also in line with research conducted within the “basic symptom” approach, which has identified transitional sequences from initial, non-psychotic basic symptoms to full-blown FRS [42].…”

Exploring schizophrenia spectrum psychopathology in borderline personality disorder

“…In conclusion, this study of 30 clinically diagnosed BPD patients reveals that when polythetic criteria are carefully applied on the basis of a comprehensive psychiatric assessment involving senior level psychologist and psychiatrist, a substantial majority of these patients fulfill in fact the diagnostic criteria of the schizophrenia spectrum. Similar results have recently been reported for patients with obsessive-compulsive disorder (OCD) [67]. This seems to indicate that the original psychopathological prototypes and the conceptual understanding of the single symptoms have gone into oblivion and that clinicians are, therefore, liable to form their own (idiosyncratic) prototypes.…”

Determinants of Schizophrenia Endophenotypes Based on Neuroimaging and Biochemical Parameters

“…The literature on the subject also includes descriptions of personality traits of schizotypes that predispose one to the development of schizophrenia or with a clinical picture similar to schizophrenia (schizotypal personality) [ 10 ]. As reported in the literature on the subject, this definition, as well as the progress made in research on the human genome and neuroimaging techniques in psychiatry, shows the polygenic nature of schizophrenia with its various causative factors, i.e., genetic, immunological, biochemical, and environmental [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”