The Utility of Electromagnetic Activity Measures in Obsessive Compulsive Disorder and Schizophrenia

Abstract

The prevalence of both OCD and SCZ is high, with estimates across the globe ranging from 1-2% of the population [1][2][3][4]. There is significant morbidity associated with both of these conditions [5]. Symptoms of these diseases may impact the individual's family, and ability to work and contribute to society. The quality of life of patients with OCD is impaired primarily during the symptomatic state but less so when patients are treated or in remission [6,7]. Close to 76% of patients with SCZ are unable to engage in basic social roles, even when psychotic symptoms are in remission; few marry, and less than one third are in regular employment [8]. Nine to thirteen percent of patients with schizophrenia commit suicide [9].The prevalence of obsessive compulsive symptoms in patients with SCZ ranges from 7.8%[10] to 25% [11]. Whereas less than 2% of patients with OCD develop psychotic symptoms [12]. The age of onset of OCD is bimodal with peaks both in children and young adults [13]; the typical age of onset of SCZ is in the third decade of life with childhood onset being extremely rare [14]. Clinical characteristicsThe clinical presentation of OCD and SCZ is currently what is used to diagnose and distinguish these conditions. OCD is characterized by the presence of obsessions and/or compulsions [15]. Obsessions are unwanted thoughts or images that recur. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform. Patients with OCD often describe either a sense of incompleteness if a ritual is not done just right or a sense that something bad will happen if they don't perform the ritual. SCZ, on the other hand, is characterized by positive and negative symptoms [15]. Positive symptoms refer to additional symptoms that are not present in a healthy individual such as hallucinations, delusions, and thought disorder. Negative symptoms refer to deficits, such as, lack of facial expressions and emotional variability, decreased energy and diminished verbal output. Cognitive dysfunction [16] and disorganized behavior may be present as well and include disorganized speech, bizarre behavior and poor attention [17].While OCD and SCZ are described as distinct psychiatric disorders [18], some authors argue that a "schizo-obsessive disorder" exists as well [19][20][21]. Indeed, a subset of individuals with SCZ present with obsessive compulsive symptoms and a subset of patients with OCD lack insight. Some have concluded from this overlap, that there is a spectrum of disorders that ranges from: [1] OCD, [2] OCD with poor insight, [3] OCD with schizotypal personality disorder, [4] schizophrenia with obsessive compulsive symptoms, [5] SCZ with OCD and [6] SCZ [22].