Obsessive-compulsive symptoms interact with disorganization in influencing social functioning in schizophrenia

Abstract

Objective Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptoms (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently. Method Seventy-five patients affected by schizophrenia were administered the Structured Clinical Interview for DSM-IV Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment. The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high OCS group). Results In both groups, the effect of OCS on functioning was not mediated by their effect on positive, negative or disorganization symptoms. Conversely, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at high levels of disorganization. Conclusion Data suggest that in patients with functioning at least in part depends on the interaction between disorganization and OCS. Particularly, since mild OCS contribute to lesser functional decline in patients with low disorganized psychosis, they may favor the constitution of a subtype of schizophrenia with a better functioning. In keeping with the historical concept of pseudoneurotic schizophrenia, we speculate that obsessive dimension might have a pathoplastic influence, balancing the effect of low disorganization symptoms.