Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment

Literature from the turn of the 20th Century to the present suggests that obsessive compulsive symptoms occur among persons with schizophrenia at rates that far exceed what is found among persons not suffering from psychoses. Less clear, however, is the significance of those symptoms. Are obsessive compulsive symptoms, for instance, related to other aspects of schizophrenia or do they represent another isolated dimension of distress? To address this issue, a review of studies is presented that explores the relationships between obsessive compulsive symptoms; positive, negative and depressive symptoms; psychosocial dysfunction; and neurocognitive deficits. Results are interpreted as indicating that obsessive compulsive symptoms are linked with graver impairments in psychosocial function. Regarding the relationship between obsessive compulsive symptoms and neurocognition, results from across a broad range of studies are equivocal. A review of studies of pharmacological treatments for obsessive compulsive symptoms has also failed to produce consistent results. While some agents have been found to lead to improvement in obsessive compulsive symptoms, other studies suggest that these medications may exacerbate those same symptoms. In general, it appears that, at best, there are currently few effective treatments. Directions for future research are reviewed. Recommendations include the development of tailored psychological and psychopharmacological interventions, and the implementation of longitudinal studies sensitive to the possibility that there are qualitatively distinct groups of patients with schizophrenia and obsessive compulsive symptoms.