Back to table of contents Previous article Next article LetterFull AccessObsessive-Compulsive Schizophrenia: A New Diagnostic Entity?Ilya Reznik, M.D., Roberto Mester, M.D., , Moshe Kotler, M.D., , and Abraham Weizman, M.D., Ilya ReznikSearch for more papers by this author, M.D., Roberto MesterSearch for more papers by this author, M.D., Ness-Ziona Mental Health Center, Ness-Ziona, Israel, Moshe KotlerSearch for more papers by this author, M.D., Faculty of Health Sciences, Ben Gurion University of the Negev, Israel, and Abraham WeizmanSearch for more papers by this author, M.D., Felsenstein Medical Research Center, Petach Tikva, IsraelPublished Online:1 Feb 2001AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: We read with great interest the recent article of Hwang et al.1 in which the clinical and neuropsychiatric features of schizophrenic subjects with severe and persistent obsessive-compulsive (OC) symptoms were investigated. The findings of this study replicated a known fact that OC-schizophrenia patients have a worse clinical course, showing poor treatment response and greater impairment of functioning.2 The authors also revealed that OC-schizophrenia patients showed an atypical set of clinical and neuropsychological characteristics, consisting of a higher level of negative symptoms, worse overall psychopathology, and significantly more impaired performance on the Wisconsin Card Sorting Test, raising a possibility of greater prefrontal pathology.1Schizophrenia with concurrent OC symptoms is of great interest. The etiology of OC phenomena in schizophrenia remains unclear. There is significant overlap of the proposed functional circuits and dysfunction at the neurotransmitter level between OCD and schizophrenia, which may lead to co-expression of symptoms. The interactions are multiple and complex, especially in regard to the serotonin and dopamine systems.3 Today controversy centers on whether there is a continuum or overlap in psychopathology between these entities that some authors have called “schizo-obsessive disorder.”4 Within this type, several clinically discrete groups were described: OCD patients who become psychotic; schizophrenic patients with comorbid OCD; schizophrenic patients exhibiting OC symptoms; and patients with comorbid OCD and schizotypal personality disorder.5 Existence of these groups may explain the diversity in epidemiological data, clinical manifestations and course, outcomes of various treatments, and prognosis.5OCD in schizophrenic patients, at least in the early stages of the disease, may have a “protective” effect regarding some psychotic symptoms and may be responsible for a less virulent course of illness and a higher level of functioning.6 On the other hand, patients with “OC schizophrenia” tended to have a more chronic course, a greater frequency of social and occupational impairment, and a poor long-term outcome.1,2,6 Treatment with serotonin reuptake blockers, added to the neuroleptic, was found to be efficacious in the treatment of obsessions and compulsions and to improve overall schizophrenic symptoms.7Most recently Berman at al.,8 using neurocognitive testing, pointed out the lack of correlation between OC and positive and negative symptomatology in schizophrenia and concluded that OC symptoms may constitute a distinct cluster, separate from psychosis, in schizophrenia and may possibly indicate a distinct subtype of schizophrenia. Their report underscores the importance of the findings of Hwang et al.,1 which support this point of view, and gives an additional strong clinical-neuropsychological complement to establishing the borders of a new diagnostic entity within the OCD-schizophrenia spectrum category. This very interesting area warrants more systematic studies to delve into this question further.References1 Hwang MY, Morgan JE, Losconzcy MF: Clinical and neuropsychological profiles of obsessive-compulsive schizophrenia: a pilot study. J Neuropsychiatry Clin Neurosci 2000; 12:91–94Link, Google Scholar2 Fenton WS, McGlashan TH: The prognostic significance of obsessive compulsive symptoms in schizophrenia. Am J Psychiatry 1986; 143:437–441Crossref, Medline, Google Scholar3 Tibbo P, Warneke L: Obsessive-compulsive disorder in schizophrenia: epidemiologic and biologic overlap. J Psychiatry Neurosci 1999; 24:15–24Medline, Google Scholar4 Zohar J: Is there room for a new diagnostic subtype: the schizo-obsessive subtype? CNS Spectrums 1997; 2:49–50Google Scholar5 Eisen JL, Phillips KA, Rasmussen SA: Obsessions and delusions: the relationship between obsessive-compulsive disorder and the psychotic disorders. Psychiatr Ann 1999: 29:515–522Google Scholar6 Poyurovsky M, Fuchs C, Weizman A: Obsessive-compulsive disorder in patients with first-episode schizophrenia. Am J Psychiatry 1999; 156:1998–2000Google Scholar7 Berman I, Sapers BL, Chang HH, et al: Treatment of obsessive-compulsive symptoms in schizophrenic patients with clomipramine. J Clin Psychopharmacol 1995; 15:206–210Crossref, Medline, Google Scholar8 Berman I, Merson A, Viegner B, et al: Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study. J Nerv Ment Dis 1998; 186:150–156Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByObsessive-Compulsive Disorder with Psychotic Features: Is It a Clinical Entity?29 September 2022 | Healthcare, Vol. 10, No. 10Psychiatry Research, Vol. 197, No. 3Síntomas obsesivo-compulsivos en pacientes con patologías del espectro esquizofrénico: frecuencia y relación con características clínicasRevista Colombiana de Psiquiatría, Vol. 40, No. 1Schizotypal traits, obsessive-compulsive symptoms, and social functioning in adolescentsComprehensive Psychiatry, Vol. 51, No. 1 Volume 13Issue 1 February 2001Pages 115-116 Metrics History Published online 1 February 2001 Published in print 1 February 2001