Schizophrenia with Obsessive-Compulsive Symptoms: Clinical and Conceptual Issues

Abstract

CME Educational Objectives 1. Develop familiarity with the diverse pathogeneses and subtyping strategies in obsessive-compulsive schizophrenia and examine their corresponding treatment options. 2. Consider the use of adjunctive cognitive behavioral therapy for obsessive-compulsive disorder in clinically stable patients with schizophrenia or schizoaffective disorder. 3. Incorporate knowledge of the patient’s clinical history, pathogenesis and pharmaco-behavioral therapy in the development of individualized treatment strategies. Since its debut in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision ( DSM-IV-TR ), the recognition of obsessive-compulsive disorder (OCD) as a comorbidity in schizophrenia has steadily increased to an estimated rate of 12% to 23% from less than 5% in the early 20th century. 1–3 Evidence also suggests that the rates of OCD or obsessive-compulsive symptoms (OCS) vary according to the stage of psychotic illness and are perhaps more prevalent in those at high risk of developing schizophrenia. 2