Skip to main content
SpringerLink
Log in

Epidemiology: Prevalence and Clinical Characteristics of Obsessive-Compulsive Disorder and Obsessive-Compulsive Symptoms in Patients with Psychotic Disorders

  • Chapter
  • First Online:
Obsessive-Compulsive Symptoms in Schizophrenia

Abstract

Obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) frequently occur in patients with schizophrenia and other psychotic disorders. Meta-analysis estimates that 12 % of patients experience additional OCD, while about 30 % report any obsessions or compulsions. Meta-regression analyses revealed that the large variability of prevalence rates between individual studies can mainly be explained by methodological differences and differences in sample characteristics. Prevalence estimations increased when more comprehensive, OCS-specific assessment instruments were used and when patients in later stages of psychotic illness were investigated.

The heterogeneous clinical presentation of occurring OCS/OCD with symptom onset prior to, concurrent with and subsequent to first psychotic manifestation suggests diverse aetiological explanations. Based on differences in onset and longitudinal course of symptoms over time, subgroups within the co-morbid sample are defined. In order to validate the proposed subcategorization, further prospective research is needed to investigate pathogenic mechanisms, including the influence of genetic, environmental and individual factors, as well as symptom interaction. Based on these findings, effective treatment strategies can hopefully be developed and adapted to specific needs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Achim A, Maziade M, Raymond E, Olivier D, Merette C, Roy M (2011) How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 37:811–821

    Article  PubMed Central  PubMed  Google Scholar 

  • Angst J, Gamma A, Endrass J, Goodwin R, Ajdacic V, Eich D, Rössler W (2004) Obsessive-compulsive severity spectrum in the community: prevalence, comorbidity, and course. Eur Arch Psychiatry Clin Neurosci 254:156–164

    PubMed  Google Scholar 

  • Bechdolf A, Mueller H, Stoetzer H, Wagner M, Maier W, Lautenschlager M, Heinz A, de Millas W, Janssen B, Gaebel W, Michel TM, Schneider F, Lambert M, Naber D, Bruene M, Krueger-Oezguerdal S, Wobrock T, Riedel M, Klosterk+Âtter J, PREVENT study group (2011) Rationale and Baseline Characteristics of PREVENT: a second-generation intervention trial in subjects at-risk (prodromal) of developing first-episode psychosis evaluating cognitive behavior therapy, aripiprazole, and placebo for the prevention of psychosis. Schizophr Bull 37:S111–S121

    Article  PubMed Central  PubMed  Google Scholar 

  • Beckmann H, Bartsch AJ, Neumärker K-J, Pfuhlmann B, Verdaguer MF, Franzek E (2000) Schizophrenia in the Wernicke-Kleist-Leonhard school. Am J Psychiatry 157:1024–1025

    Article  CAS  PubMed  Google Scholar 

  • Bottas A, Cooke RG, Richter MA (2005) Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: is there evidence for a schizo-obsessive subtype of schizophrenia? J Psychiatry Neurosci 30:187–193

    PubMed Central  PubMed  Google Scholar 

  • Braga RJ, Reynolds GP, Siris SG (2013) Anxiety comorbidity in schizophrenia. Psychiatry Res 210:1–7

    Article  PubMed  Google Scholar 

  • Bräunig P, Krüger S, Shugar G, Höffler J, Börner I (2000) The catatonia rating scale I–development, reliability, and use. Compr Psychiatry 41:147–158

    Article  PubMed  Google Scholar 

  • Buckley P, Miller B, Lehrer D, Castle D (2009) Psychiatric comorbidities and schizophrenia. Schizophr Bull 35:383–402

    Article  PubMed Central  PubMed  Google Scholar 

  • Cederlof M, Lichtenstein P, Larsson H, Boman M, Ruck C, Landen M, Mataix-Cols D (2014) Obsessive-compulsive disorder, psychosis, and bipolarity: a longitudinal cohort and multigenerational family study. Schizophr Bull. doi:10.1093/schbul/sbu169

    PubMed  Google Scholar 

  • Craig T, Hwang MY, Bromet EJ (2002) Obsessive-compulsive and panic symptoms in patients with first-admission psychosis. Am J Psychiatry 159:592–598

    Article  PubMed  Google Scholar 

  • Cunill R, Castells X, Simeon D (2009) Relationships between obsessive-compulsive symptomatology and severity of psychosis in schizophrenia: a systematic review and meta-analysis. J Clin Psychiatry 70:70–82

    Article  PubMed  Google Scholar 

  • de Haan L, Linszen DH, Gorsira R (1999) Clozapine and obsessions in patients with recent-onset schizophrenia and other psychotic disorders. J Clin Psychiatry 60:364–365

    Article  PubMed  Google Scholar 

  • de Haan L, Beuk N, Hoogenboom B, Dingemans P, Linszen D (2002) Obsessive-compulsive symptoms during treatment with olanzapine and risperidone: a prospective study of 113 patients with recent-onset schizophrenia or related disorders. J Clin Psychiatry 63:104–107

    Article  PubMed  Google Scholar 

  • de Haan L, Oekeneva A, van Amelsvoort T, Linszen D (2004) Obsessive-compulsive disorder and treatment with clozapine in 200 patients with recent-onset schizophrenia or related disorders. Eur Psychiatry J Assoc Eur Psychiatrists 19:524

    Article  Google Scholar 

  • de Haan L, Hoogenboom B, Beuk N, van Amelsvoort T, Linszen D (2005) Obsessive-compulsive symptoms and positive, negative, and depressive symptoms in patients with recent-onset schizophrenic disorders. Can J Psychiatry Revue Canadienne de Psychiatrie 50:519–524

    Google Scholar 

  • de Haan L, Hoogeboom B, Beuk N, Wouters L, Dingemans PM, Linszen DH (2006) Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale in schizophrenia patients. Psychopharmacol Bull 39:25–30

    PubMed  Google Scholar 

  • de Haan L, Dudek-Hodge C, Verhoeven Y, Denys D (2009) Prevalence of psychotic disorders in patients with obsessive-compulsive disorder. CNS Spectr 14:415–417

    PubMed  Google Scholar 

  • de Haan L, Sterk B, Wouters L, Linszen DH (2012) The 5-year course of obsessive-compulsive symptoms and obsessive-compulsive disorder in first-episode schizophrenia and related disorders. Schizophr Bull 39:151–160

    Article  Google Scholar 

  • de Haan L, Sterk B, van der Valk R (2013) Presence of obsessive compulsive symptoms in first-episode schizophrenia or related disorders is associated with subjective well-being and quality of life. Early Interv Psychiatry 7:285–290

    Article  PubMed  Google Scholar 

  • DeVylder JE, Oh AJ, Ben-David S, Azimov N, Harkavy-Friedman JM, Corcoran CM (2012) Obsessive compulsive symptoms in individuals at clinical risk for psychosis: association with depressive symptoms and suicidal ideation. Schizophr Res 140:110–113

    Article  PubMed Central  PubMed  Google Scholar 

  • Dowling FG, Pato MT, Pato CN (1995) Comorbidity of obsessive-compulsive and psychotic symptoms: a review. Harv Rev Psychiatry 3:75–83

    Article  CAS  PubMed  Google Scholar 

  • Ebel H, Gross G, Klosterkotter J, Huber G, Ebel H, Gross G, Klosterkotter J, Huber G (1989) Basic symptoms in schizophrenic and affective psychoses. Psychopathology 22:224–232

    Article  CAS  PubMed  Google Scholar 

  • Fineberg NA, Hengartner MP, Bergbaum CE, Gale TM, Gamma A, Ajdacic-Gross V, Rössler W, Angst J (2013) A prospective population-based cohort study of the prevalence, incidence and impact of obsessive-compulsive symptomatology. Int J Psychiatry Clin Pract 17:170–178

    Article  PubMed  Google Scholar 

  • Fink M (2013) Rediscovering catatonia: the biography of a treatable syndrome. Acta Psychiatr Scand Suppl 127:1–47

    Article  Google Scholar 

  • Fink M, Taylor MA (2001) The many varieties of catatonia. Eur Arch Psychiatry Clin Neurosci 251(Suppl 1):I8–I13

    Article  PubMed  Google Scholar 

  • Fontenelle LF, Lin A, Pantelis C, Wood SJ, Nelson B, Yung AR (2011) A longitudinal study of obsessive-compulsive disorder in individuals at ultra-high risk for psychosis. J Psychiatr Res 45:1140–1145

    Article  PubMed  Google Scholar 

  • Fusar-Poli P, Nelson B, Valmaggia L, Yung AR, McGuire PK (2012) Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophr Bull 40:120–131

    Article  PubMed Central  PubMed  Google Scholar 

  • Guillem F, Satterthwaite J, Pampoulova T, Stip E (2009) Relationship between psychotic and obsessive compulsive symptoms in schizophrenia. Schizophr Res 115:358–362

    Article  PubMed  Google Scholar 

  • Hur JW, Shin NY, Jang JH, Shim G, Park HY, Hwang JY, Kim SN, Yoo JH, Hong KS, Kwon JS (2012) Clinical and neurocognitive profiles of subjects at high risk for psychosis with and without obsessive-compulsive symptoms. Aust N Z J Psychiatry 46:161–169

    Article  PubMed  Google Scholar 

  • Hwang MY, Kim SW, Yum SY, Opler LA (2009) Management of schizophrenia with obsessive-compulsive features. Psychiatr Clin N Am 32:835–851

    Article  Google Scholar 

  • Lencz T, Smith CW, Auther A, Correll CU, Cornblatt B (2004) Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophr Res 68:37–48

    Article  PubMed  Google Scholar 

  • Lysaker PH, Whitney KA (2009) Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment. Expert Rev Neurother 9:99–107

    Article  PubMed  Google Scholar 

  • Meier SM, Petersen L, Pedersen MG, Arendt MC, Nielsen PR, Mattheisen M, Mors O, Mortensen PB (2014) Obsessive-compulsive disorder as a risk factor for schizophrenia: a nationwide study. JAMA Psychiatry 71:1215–1221

    Article  PubMed  Google Scholar 

  • Meijer JH, Sweets M, Keeman S, Nieman DH, Meijer CJ, Consortium G (2012) Does a schizo-obsessive subtype exist from a cognitive perspective? Results from a large cross-sectional study in patients with psychosis and their unaffected relatives. J Nerv Ment Dis 201:30–35

    Article  Google Scholar 

  • Mukhopadhaya K, Krishnaiah R, Taye T, Nigam A, Bailey AJ, Sivakumaran T, Fineberg NA (2009) Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause for clinical concern. J Psychopharmacol 23:6–13

    Article  CAS  PubMed  Google Scholar 

  • Murphy DL, Timpano KR, Wheaton MG, Greenberg BD, Miguel EC (2010) Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts. Dialogues Clin Neurosci 12:131–148

    PubMed Central  PubMed  Google Scholar 

  • Niendam TA, Berzak J, Cannon TD, Bearden CE (2009) Obsessive compulsive symptoms in the psychosis prodrome: correlates of clinical and functional outcome. Schizophr Res 108:170–175

    Article  PubMed Central  PubMed  Google Scholar 

  • Pedersen C, Mors O, Bertelsen A et al (2014) A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 71:573–581

    Article  PubMed  Google Scholar 

  • Poyurovsky M (2013) Schizo-obsessive disorder. Cambridge University Press, New York

    Book  Google Scholar 

  • Poyurovsky M, Fuchs C, Weizman A (1999) Obsessive-compulsive disorder in patients with first-episode schizophrenia. Am J Psychiatry 156:1998–2000

    CAS  PubMed  Google Scholar 

  • Poyurovsky M, Zohar J, Glick I, Koran LM, Weizman R, Tandon R, Weizman A (2012) Obsessive-compulsive symptoms in schizophrenia: implications for future psychiatric classifications. Compr Psychiatry 53:480–483

    Article  PubMed  Google Scholar 

  • Reznik I, Mester R, Kotler M, Weizman A (2001) Obsessive-compulsive schizophrenia: a new diagnostic entity? J Neuropsychiatry Clin Neurosci 13:115–116

    Article  CAS  PubMed  Google Scholar 

  • Rosen JL, Miller TJ, D’Andrea JT, McGlashan TH, Woods SW (2006) Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome. Schizophr Res 85:124–131

    Google Scholar 

  • Rubino IA, Frank E, Croce NR, Pozzi D, di Lanza ST, Siracusano A (2009) A comparative study of axis I antecedents before age 18 of unipolar depression, bipolar disorder and schizophrenia. Psychopathology 42:325–332

    Article  PubMed  Google Scholar 

  • Schirmbeck F, Zink M (2012) Obsessive-compulsive syndromes in schizophrenia: a case for polypharmacy? In: Ritsner M (ed) Polypharmacy in psychiatric practice. Springer, Dordrecht. ISBN 978-94-007-5798-1

    Google Scholar 

  • Schirmbeck F, Zink M (2013) Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors. Front Pharmacol 4:99

    Article  PubMed Central  PubMed  Google Scholar 

  • Schirmbeck F, Esslinger C, Rausch F, Englisch S, Meyer-Lindenberg A, Zink M (2011) Antiserotonergic antipsychotics are associated with obsessive-compulsive symptoms in schizophrenia. Psychol Med 41:2361–2374

    Article  CAS  PubMed  Google Scholar 

  • Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M (2013) Differential effects of antipsychotic agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol 27:349–357

    Article  CAS  PubMed  Google Scholar 

  • Sevincok L, Akoglu A, Arslantas H (2006) Schizo-obsessive and obsessive-compulsive disorder: comparison of clinical characteristics and neurological soft signs. Psychiatry Res 145:241–248

    Article  PubMed  Google Scholar 

  • Shioiri T, Shinada K, Kuwabara H, Someya T (2007) Early prodromal symptoms and diagnoses before first psychotic episode in 219 inpatients with schizophrenia. Psychiatry Clin Neurosc 61:348–354

    Article  Google Scholar 

  • Stengel E (1945) A study on some clinical aspects of the relationship between obsessional neurosis and psychotic reaction types. J Ment Sci 91:166–187

    Google Scholar 

  • Sterk B, Lankreijer K, Linszen DH, de Haan L (2011) Obsessive-compulsive symptoms in first episode psychosis and in subjects at ultra high risk for developing psychosis; onset and relationship to psychotic symptoms. Aust N Z J Psychiatry 45:400–405

    Article  PubMed  Google Scholar 

  • Strakowski SM, Tohen M, Stoll AL, Faedda GL, Mayer PV, Kolbrener ML, Goodwin DC (1993) Comorbidity in psychosis at first hospitalization. Am J Psychiatry 150:752–757

    Article  CAS  PubMed  Google Scholar 

  • Strakowski SM, Keck PE Jr, McElroy SL, Lonczak HS, West SA (1995) Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry 36:106–112

    Article  CAS  PubMed  Google Scholar 

  • Sullwold L, Huber G (1986) Basic schizophrenic disorders. Monographien aus dem Gesamtgebiete der Psychiatrie Psychiatry Series 42:1–177

    Article  CAS  Google Scholar 

  • Swets M, Dekker J, van Emmerik-van Oortmerssen K, Smid GE, Smit F, de Haan L, Schoevers RA (2014) The obsessive compulsive spectrum in schizophrenia, a meta-analysis and meta-regression exploring prevalence rates. Schizophr Res 152:458–468

    Article  PubMed  Google Scholar 

  • Ãœcok A, Ceylan ME, Tihan AK, Lapcin S, Ger C, Tükel R (2011) Obsessive compulsive disorder and symptoms may have different effects on schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 35:429–433

    Article  PubMed  Google Scholar 

  • Westphal K (1878) Ueber Zwangsvorstellungen. Arch Psychiatr Nervenkr 8:734–750

    Google Scholar 

  • Woody SR, Steketee G, Chambless DL (1995) Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behav Res Ther 33:597–605

    Article  CAS  PubMed  Google Scholar 

  • Zink M, Schirmbeck F, Rausch F, Eifler S, Elkin H, Solojenkina X, Englisch S, Wagner M, Maier W, Lautenschlager M, Heinz A, Gudlowski Y, Janssen B, Gaebel W, Michel TM, Schneider F, Lambert M, Naber D, Juckel G, Krueger-Oezguerdal S, Wobrock T, Hasan A, Riedel M, Müller H, Klosterkötter J, Bechdolf A (2014) Obsessive–compulsive symptoms in at-risk mental states for psychosis: associations with clinical impairment and cognitive function. Acta Psychiatr Scand 130:214–226

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands

    Frederike Schirmbeck PhD

  2. Arkin Mental Health and Addiction Treatment Centre, Amsterdam, The Netherlands

    Marije Swets

  3. Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Lieuwe de Haan

Authors
  1. Frederike Schirmbeck PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marije Swets
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lieuwe de Haan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederike Schirmbeck PhD .

Editor information

Editors and Affiliations

  1. Dept. of Psychiatry, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands

    Lieuwe De Haan

  2. Department of Psychiatry, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands

    Frederike Schirmbeck

  3. Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany

    Mathias Zink

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Schirmbeck, F., Swets, M., de Haan, L. (2015). Epidemiology: Prevalence and Clinical Characteristics of Obsessive-Compulsive Disorder and Obsessive-Compulsive Symptoms in Patients with Psychotic Disorders. In: De Haan, L., Schirmbeck, F., Zink, M. (eds) Obsessive-Compulsive Symptoms in Schizophrenia. Springer, Cham. https://doi.org/10.1007/978-3-319-12952-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-12952-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-12951-8

  • Online ISBN: 978-3-319-12952-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation