Co-occurrence of OCS and psychotic illness was recently revived because of increased recognition of higher than expected comorbidity rates and observations of the emergence or exacerbation of OCS during treatment of psychosis with atypical antipsychotics 18–20. Despite growing knowledge about OCD and schizophrenia, little is known about the links between them, and, to our knowledge, only a few studies have investigated the relationship between OCS and OCD in Egyptian schizophrenic patients. Therefore, the aim of the study was to ascertain the frequency of OCS among patients with schizophrenia in an Egyptian patient sample and assess the relation between the two disorders.
In this study, the frequency of OCS and OCD among Egyptian schizophrenic patients was estimated to be 23.3 and 13.3%, respectively. This is consistent with the results of other studies, which have revealed comorbidity rates for OCS in the schizophrenia population of 10–52% 7,21,22 and for OCD of 7.8–26% 23–27. In addition, In Malaysia, Abdul Hamid and Abdul Razak 28 reported that 15% of their schizophrenic sample met the criteria for OCD. In another study conducted in Iran on 100 schizophrenic patients (in whom antipsychotics were stopped for at least 1 week and who were studied during the first 10 days of hospitalization), 10% had OCD, of whom 6% had OCD before the onset of schizophrenia 29. These results indicate that schizophrenic patients have a higher possibility of developing OCD when compared with the normal population. However, the observations of the emergence of new OCS with atypical antipsychotic treatment for schizophrenia 18–20,30 raise the possibility that some of these comorbid OCD cases are medication induced. Guillem et al. 31 also reveal a strong positive relationship between psychosis and OCS, which suggests that they share common mechanisms.
The most frequent obsessions were contamination (30%), religious obsession (26.7%), and sexual ideas (16.7%). The most common compulsions were cleaning (33%), checking (23.3%), and hoarding (16.7%). Patients with schizophrenia had higher degree of indecisiveness, pervasive slowness, pathological doubting, global severity, and reliability scores. In previous studies also the types of obsessions and compulsions experienced by patients with schizophrenia were similar to those found in our results 26,29. Türkcan et al. 32 have reported contamination and sexual obsessions, cleaning compulsions, and repetitive rituals in schizophrenic patients. In addition, in the study by De Haan et al. 33 the obsessions found were similar to ours but checking, arranging, repetition, and washing compulsions had higher prevalence. The differences in types of symptoms in different studies can be due to the characteristics of the disorder, personality background, psychopathology, and chronicity of schizophrenia, course of the disorder, and culture impact.
There was no significant correlation between admission times (as a reflection of the duration of illness) and YBOCS score. These results are in accordance with those of Hosseini et al. 29, who reported no significant relationship between demographic factors, rank of hospitalization, duration of symptoms, age, and severity of schizophrenia in the group with OCS, but are in contrast to the results of Hemrom et al. 36 and Jaydeokar et al. 34, who suggested that schizophrenic patients with OCS had significantly longer duration of illness. These symptoms were more prominent in patients with more than 5 years of total duration of illness.
With regard to DSM-IV Axis IV (GAF), in our study the Axis IV score was higher among those diagnosed clinically with OCS compared with those who were not (60±16.3 vs. 54.48±15.8); yet, no statistical significance was found between the two groups (P=0.17). In contrast, Nolfe et al. 37 found that the average GAF scores were higher in patients without OCS compared with patients with OCS. This discrepancy may be attributed either to the small number of our sample or to the fact that OCS in schizophrenia has a protective effect on functioning. Therefore, the GAF should be applied on a larger sample of patients for further validation.
The present study has several limitations. The small sample size might have affected the accuracy of the prevalence rate and factors associated with OCS in schizophrenic patients and prevented us from conducting further analyses comparing subgroups based on diagnosis. Moreover, the cross-sectional nature of the study limited our ability to draw causal inferences on OCS or OCD and schizophrenia. Further, we did not investigate the drug history of the patients in a way that could be included in a research to reveal the effects of antipsychotic medications on OCS. Despite these limitations, the current findings are important in clarifying the relation between OCS and schizophrenia, and provide guidance for future research.
In conclusion, OCS are prevalent among schizophrenic patients, especially among those with paranoia, and strongly affect the global functions of those patients.
Detailed assessment of schizophrenic patients is required to evaluate probable comorbid OCS as subsyndromal symptoms as it may require treatment for a longer duration and possibly require additional interventions.
The authors thank patients and controls for their participation and cooperation.
There are no conflicts of interest.
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