Do Obsessive-Compulsive Symptoms Increase the Risk of Developing Psychosis? A Systematic Review and Meta-analysis

Area of Science:

• Psychiatry
• Clinical Psychology
• Epidemiology

Background:

• Obsessive-compulsive symptoms (OCSs) share phenomenological overlap with psychosis.
• Previous research on OCSs and psychosis risk has primarily focused on clinical high-risk (CHR) cohorts.
• Sampling biases in CHR cohorts may misestimate the true risk of OCSs for developing psychosis.

Purpose of the Study:

• To systematically review and meta-analyze the risk of OCSs in developing psychosis.
• To assess this risk in both clinical high-risk (CHR) and population-level cohorts.
• To address potential sampling biases in previous reviews.

Main Methods:

• Systematic review and meta-analysis of 11 selected studies.
• Two separate meta-analyses were conducted: one for CHR cohorts and one for register-based (population-level) cohorts.
• Risk ratios (RR) were calculated to estimate the association between OCSs and psychosis development.

Main Results:

• In CHR cohorts, no significant difference in psychosis risk was found between individuals with and without OCSs (RR=0.99, P=0.95).
• In register-based cohorts, OCSs were associated with a 15-fold increase in psychosis risk (RR=15.01, P<.001).
• Significant heterogeneity was noted in the register-based cohort analysis (I²=85.1%).

Conclusions:

• OCSs may increase the risk of developing psychosis in population-level cohorts, but not in CHR cohorts.
• The discrepancy suggests shared underlying vulnerabilities for OCSs and psychosis that may be masked in CHR samples.
• Further research is needed, acknowledging limitations due to study numbers and heterogeneity in population-level data.