Obsessive-compulsive symptoms in first episode psychosis and risk states: Systematic review with meta-analysis

Background and hypothesis: Recent studies have reported high prevalences of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients. This sparked an interest in the effect of these symptoms in the clinical characteristics and outcomes of patients. However these studies have never been formally meta-analyzed.Study design: Systematic review and meta-analysis of prevalence of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients and comparison of clinical charac-teristics and outcomes in patients with and without obsessive-compulsive symptoms.Study results: Obsessive-compulsive disorder was present in 7.9 % (5.9 to 10.0 %) and 10.5 % (8.3 to 12.8 %) and obsessive-compulsive symptoms in 21.4 % (8.3 to 38.2 %) and 34.0 % (26.3 to 42.1 %) of at risk and first episode psychosis patients respectively. The prevalences of obsessive-compulsive symptoms had high heterogeneity due in part to different measurement methods and cut-off values. Similar ages of onset for OCS and psychosis symptoms were found (mean difference -0.49 years, 95 % CI-1.74 to 0.77). Patients with obsessive-compulsive symptoms had statistically insignificant higher Positive and Negative Syndrome Scale (positive subscale) scores and marginally higher depression scores. There were no differences between both groups in age of onset, Positive and Negative Syndrome Scale (negative subscale) score, risk of conversion to psychosis, anxiety score, suicide rate, and functionality score.Conclusions: Obsessive-compulsive disorder and obsessive-compulsive symptoms are very prevalent in at risk and first-episode psychosis patients.