The boundaries between obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders (SSD) are ambiguous. While it is known that obsessive–compulsive-like symptoms are present in SSD, there is also evidence that poor insight OCD relates closely to SSD.
The authors aim to explore que relationship between OCD and SSD and report an illustrative clinical case.
Case report and non-systematic literature review through literature research on Pubmed with the words "obsessive compulsive disorder", "schizophrenia" and “schizo-obsessive spectrum”.
The classical psychopathological concept of "true obsessions" required intact insight and resistance. Currently, the OCD criteria on DSM-5 can include obsessions with “absent insight/delusional beliefs”. In clinical setting it's hard to distinguish OCD with poor insight obsessions and/or psychotic features from the delusions in Schizophrenia. This is demonstrated in the case report of a 19 year-old male, presenting for the first time with obsessions of contamination and compulsions of cleanliness with bizarre behaviours, without insight, that had been aggravating for 1 year.
It’s of great importance to understand OCD at the phenomenological level and investigate the possible association with SSD, to allow for adequate diagnosis, treatment, with longitudinal evaluation being essential to predict prognosis. Some authors advocated that OCD and Schizophrenia should be conceptualized as a spectrum based on a continuum of insight - the schizo-obsessive spectrum, with some studies reporting an increased risk for an SSD diagnosis in patients with OCD.
Neurological soft signs (NSS) are minor non-localizing neurological abnormalities without diagnostic specificity, involving defects in motor coordination, sensory integration and primitive reflexes, normally present in the course of early development but considered abnormal when present beyond childhood. NSS, indicative of subtle brain dysfunction, have been described in a variety of psychiatric entities, such as schizophrenia spectrum disorders and bipolar disorder. There is evidence linking neurological dysfunction to obsessive-compulsive disorder (OCD), but NSS have been inconsistently reported.
Our aim is to review current knowledge on the presence of NSS in OCD patients and their potential clinical importance.
Non-systematic review of literature through search on PubMed/MEDLINE electronic database for publications up to 2019, in English, following the terms “neurological soft signs” and “obsessive-compulsive disorder”.
The majority of studies indicate that OCD patients exhibit significantly higher rates of NSS on both sides of the body, with impairments in multiple domains: motor coordination, sensory integration, complex motor tests, right/left and spatial orientation, and hard signs. NSS positively correlate with the severity of disease, measured with The Yale-Brown Obsessive Compulsive Scale, and the presence of alexithymia and neuropsychological deficits. Left-sided visuospatial soft signs were intensified in pharmacological treatment non-responders compared to responders. OCD patients with poor insight appear to have higher NSS scores than those with good insight, with more impaired neurological motor performance.
Evidence supports that patients with OCD have increased rates of diverse NSS. OCD patients with NSS may have a more complicated expression of symptomatology, requiring greater clinical care.
A single 22 year-old-single man. Psychiatric history from the age of 15. Clinical start due to alterations of the circadian rhythm linked to video-games, as well as different obsessions and compulsions, being diagnosed of Obsessive Compulsive Disorder.
He required multiple admissions, both in Adolescent Psychiatry Unit and in Acute Unit of Psychiatry due to anxious symptoms, obsessive thoughts, compulsions, dysmorphophobic-somatic ideation associated with sexual functioning and alteration of male hormones, and suicidal gestures.
He had also performed therapy in different devices, such as Day Hospital and Convalescence Unit.
He strongly resists to psychopharmacological treatment, due in part to the different side effects actually suffered with diferents drugs (being clear the high sensitivity of the patient to neuroleptics and stabilizers) and partially influenced by close to delirious phase beliefs about his problems in the sexual/hormonal areas.
Last years ́ evolution show a deterioration in academic functioning (abandonment of studies), work (inability to keep a job) and even in social and family networks, reaching a point where home management has been impossible because of the continuous demands of analytical-hormonal tests, and behavioral alterations because of the refusal to yield to their demands.
Given this situation, and in agreement with the family, it is decided to seek new treatment alternatives, so the case is brought to the attention of the Reference Neurosurgery Service for Obsessive Compulsive Disorder surgery, being the case studied and accepted by the same one and being in these moments realizing psychosurgery preoperative tests.
We describe the case of a 21 year old women, without personal or family psychiatric history, who has been with low mood, high anxiety, conciliation insomnia, decreased appetite, weight loss and social withdrawal. Persistent thoughts of suicide, which are egodystonic, intrusive and rumiatives, are present since she was 15 years old. She also presents impulse phobia and fear of losing control which, together with the long-standing autolytic idea, has created the important discomfort nowadays. We consider that the possible diagnosis could be major depressive disorder (MDD) or obsessive compulsive disorder (OCD) of suicidal type.
To review the literature of MDD and suicidal OCD, study the differences between both and finally, make a differential diagnosis.
Literature review of scientific papers searching in Pubmed. We considered papers in English.
Suicidal OCD is a disorder in which the patient present thoughts related to suicide and they can also present compulsions that try to neutralize the discomfort generated by those thoughts. Patients with this type of disorder believe that they will finally carry out these ideas. For this reason, they are insecure and afraid. Like any type of OCD, it is closely related to depression. However, in this subtype, due to the content of their thoughts, it is difficult to assess whether suicidal ideation is a consequence of depression or if, on the contrary, depression derives from maintaining uncontrollable, irrational and egodystonic thoughts for a long time.
OCD is a difficult disorder to diagnose and differentiate from MDD. Therefore, it is an underdiagnosed disorder.
The Obsessive Compulsive Disorder (OCD) affects 1.2% of the general population; nevertheless the evidence suggests that postnatal OCD reaches a frequency of 4-9%.
- Perform a literature search about the psychotherapeutic and psychopharmacological intervention in the treatment of postpartum OCD.
- Report a case about OCD clinical management.
- A narrative review of the literature published, was carried out in the database MEDLINE (PubMed) between 2013 and 2018.
- We describe psychotherapeutic intervention in a case of OCD in a postpartum woman.
A 47-year-old woman with a history of OCD, in treatment with fluoxetine 40mg/d, admitted to the Obstetrics Unit for severe pre-eclampsia and intrauterine growth restriction. They request psychiatric assessment due to exacerbation contamination obsessive ideas; as well as bizarre ideas consistent in pain transmission to the baby through breathing, which avoids physical contact with her baby. It is diagnosed as an OCD puerperal decompensation with severe involvement in maternal care. The fluoxetine dose is increased to 60mg/d and it is established risperidone 0.5mg/night. Likewise, a coordinated intervention is carried out by the Perinatal Mental Health Unit and Neonatology being able to optimize psychopharmacological treatment and focusing psychotherapeutic intervention on baby exposure at the Neonatal ICU and later at Mother-Baby Day Hospital.
The literature shows that certain aspects of the postpartum period should be considered in therapeutic decisions such as psychopharmacological treatment, breastfeeding or the involvement of affective-behavioral symptoms in the baby interaction and the consequent bond establishment. Specific and specialized intervention programs are necessary for severe perinatal OCD.
Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that causes the patient to experience intrusive thoughts and/or to carry out repetitive, ritualized behaviors that are time consuming and impairing
The aim of the study is investigate the patterns of psychopharmacological prescribing in a large sample (n=1815) of patients suffering from obsessive-compulsive disorder (OCD) referred to four Italian centres specialized in OCD, in comparison to available national and international guidelines
The centers were asked to complete a specific data sheet questionnaire on patients' therapeutic status. Statistical analyses were carried out by SPSS.
The results showed that almost all patients referred to the centers of Milan, Pisa and Rome received psychotropic medications, whereas only 59.9% (313) did so in Turin. Selective serotonin reuptake inhibitors were the most used drugs ranging between 49.0% and 71.5%. Clomipramine was prescribed more often in Rome and Pisa than in Milan and Turin. The same was true for other tricyclic antidepressants. Second-generation antipsychotics were more often prescribed in Pisa and in Milan. Mood stabilizers were almost exclusively used in Pisa.
OCD patients in Italy, at least those visited in specialized centres generally receive pharmacological treatment. The prescriptions generally follow international and national guidelines, with SSRIs being the most used drugs. The differences observed amongst the centres may be related to clinical heterogeneity of the patients, in particular their severity and comorbid patterns, and local cultural and socioeconomic factors
Villaverde’s day hospital is a psychotherapeutic treatment center for adult patients (from 18 to 65 years old) with severe mental disorder. It is an intensive treatment center focused mainly in group therapy, with a therapeutic community approach. Our patients are not referred by diagnosis but by the little improvement they have with ambulatory treatment so they are usually chronic, treatment-resistant cases.
A small proportion of our cases have Obsessive-Compulsive Disorder (OCD) as a main diagnosis. One of the usual demands we receive from these patients is a worsening of their OCD symptoms without a clear cause. We have observed that, after addressing this worsening in different therapies, it usually had some relation to complicated family dynamics so we wanted to study how these dynamics affected their symptoms.
We selected cases with severe treatment-resistant OCD treated in our day hospital during 2018 and 2019 to analyze their family dynamics and how changes on this dynamics affected their symptoms.
In this period, 9,8% of our patients had OCD as main diagnosis. All the cases we received were affected by different maladjusted family dynamics and their symptoms improved once these where addressed in different ways (group and individual therapy, family interviews).
Treatment-resistant OCD patients pose an important challenge to mental health professionals. In many cases we tend to focus on their symptoms, disregarding their family dynamics. Addressing their social context and these dynamics may improve their symptoms and quality of life.
Obsessive compulsive disorder (OCD) is a severe mental disorder associated with high levels of personal, social and family burden. Several interventions have been developed to support patients and their family members, and the Fallon psychoeducational family intervention has been found one of the most effective.
The present study aims to: 1) adapt the psychoeducational family intervention according to the Falloon model to the context of OCD patients and their family members; 2) to evaluate the effectiveness of the experimental intervention in terms of reduction of the level of family burden, family accommodation and maladaptive coping strategies.
The experimental intervention has been developed on the basis of the Falloon psychoeducational model
The intervention covers the following topics: information on OCD; pharmacological and non-pharmacological treatments; family accommodation; communication skills and problem-solving strategies.
The efficacy of the intervention will be tested in a randomized controlled trial implemented at the Department of Psychiatry of the University of Campania “L. Vanvitelli”. In particular, at least 10 OCD patients and their family members will be recruited and consecutively allocated to the experimental group or to a waiting list group.
Patients and family members allocated to the experimental group are expected to report a low level of family burden and family accommodation and an improvement in problem-oriented coping strategies compared to those allocated to the waiting list.
The new psychoeducational family intervention could be useful to improve the long-term outcome of OCD patients and of their family members.