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Obsessive compulsive disorder with psychotic features

J L Eisen1, S A Rasmussen

  • 1Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, R.I.

The Journal of Clinical Psychiatry
|October 1, 1993
PubMed
Summary
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Obsessive compulsive disorder (OCD) with psychotic symptoms shows significant heterogeneity. Patients with OCD and schizophrenia-spectrum disorders differ demographically and clinically from those with OCD without insight.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Neuroscience

Background:

  • Obsessive compulsive disorder (OCD) is a mental health condition characterized by obsessions and compulsions.
  • The co-occurrence of psychotic symptoms in OCD presents diagnostic and therapeutic challenges.
  • Understanding the specific features of OCD with psychosis is crucial for effective treatment.

Purpose of the Study:

  • To systematically identify and characterize the demographic and clinical features of patients with OCD and psychotic symptoms.
  • To differentiate subtypes of OCD with psychosis based on symptom presentation and co-occurring disorders.

Main Methods:

  • A cohort of 475 patients diagnosed with DSM-III-R OCD was evaluated.
  • Patients with psychotic symptoms (hallucinations, delusions, thought disorder) were identified (n=67, 14%).

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  • Demographic and clinical data were collected via semistructured interviews and compared between psychotic and non-psychotic OCD groups.

    • Main Results:

    • Six percent (n=27) had OCD with "OCD without insight" (lack of conviction about obsessions).
    • Fourteen percent (n=67) had OCD with co-occurring psychotic disorders: schizophrenia (4%), delusional disorder (2%), and schizotypal personality disorder (3%).
    • OCD patients with psychosis, particularly schizophrenia-spectrum disorders, were more likely to be male, single, have a deteriorative course, and present earlier.

    Conclusions:

    • Significant heterogeneity exists within the population of OCD patients experiencing psychotic symptoms.
    • The clinical and demographic profiles vary substantially, especially between OCD with insight deficits and OCD with distinct psychotic disorders.
    • Findings have implications for diagnostic classification and understanding delusional states in psychiatric disorders.