OCD linked to psychosis development in high-risk patients
By Mark Cowen
15 September 2011
J Psychiatr Res 2011; 45: 1140–1145

MedWire News: Persistent and incident obsessive compulsive disorder (OCD) is associated with an increased risk for the development of psychotic disorders in patients at ultra-high risk (UHR) for such conditions, Australian study results suggest.

Writing in the Journal of Psychiatric Research, Leonardo Fontenelle (University of Melbourne) and colleagues explain: "Observations of patients with OCD indicate that the incidence of schizophrenia is low, even after long-term follow-up. In contrast, obsessive-compulsive symptoms (OCS) are noted more commonly at various stages of psychosis and schizophrenia."

But they add that "it remains unclear whether OCS/OCD bears any relationship to the emergence of psychosis and schizophrenia, or whether the two disorders are independent."

To investigate further, the team studied 312 individuals (55.1% women) at UHR for psychosis according to Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria who were followed up for a mean of 7.4 years.

Using the CAARMS, the team divided the patients into four groups consisting of 269 (86.2%) patients without OCD at baseline and follow-up (non-OCD group), 17 (5.4%) without OCD at baseline but with OCD at follow-up (incident OCD group), 20 (6.4%) with OCD at baseline but without OCD at follow-up (remitting OCD group), and six (1.9%) with OCD at baseline and at follow-up (persistent OCD group).

In total, 57 (18.2%) patients developed at least one psychotic disorder during the follow-up period.

The researchers found that those with incident OCD were more likely to develop any psychotic disorder than those in the non-OCD, remitting, and persistent OCD groups, at a rate of 62.5% versus 16.0%, 10.0%, and 40.0%, respectively. This risk was particularly high for mood disorders with psychotic features and psychotic disorders not otherwise specified (PDNOS).

The risk for schizophrenia development was highest in the persistent OCD group, at a rate of 40.0%, compared with rates of just 12.5%, 5.0%, and 9.7% in the incident, remitting, and non-OCD groups, respectively.

Fontenelle and team conclude: "Our findings suggest that, in a cohort of individuals at UHR for psychosis, remission of OCD does not increase the risk of psychosis, while de novo OCD was associated with development of mood disorders with psychotic features and PDNOS."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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