Obsessive-compulsive symptoms in first episode psychosis and in subjects at ultra high risk for developing psychosis; onset and relationship to psychotic symptoms

Objective: To determine the prevalence of obsessive-compulsive symptoms and obsessive compulsive disorder in patients with schizophrenia or related disorders or subjects at ultra high risk for development of psychosis. Secondly, to determine the time of occurrence of obsessive-compulsive symptoms related to the onset of first psychosis. Method: We collected data on all patients who were referred consecutively to our specialized clinic for first episode psychosis patients and ultra high risk subjects in Amsterdam between 1 July 2006 and 1 July 2008. Diagnosis of psychotic disorders was established using the Comprehensive Assessment of Symptoms and History schedule. Obsessions and compulsions were defined in accordance with DSM-III-R criteria and assessed by clinicians. We analyzed the onset of obsessive-compulsive symptoms and its relation to the onset of first episode psychosis. Results: When a strict definition of obsessive-compulsive symptoms is used, 9.3% (n = 18) of patients with schizophrenia or a related disorder exhibited obsessive-compulsive symptoms and 1.5% also met criteria for obsessive-compulsive disorder. The onset of obsessive -compulsive symptoms occurred before, concurrent with and after onset of first episode psychosis in the following proportion of patients: 7/18, 3/18, 8/18. We found a prevalence of 20.7% of obsessive-compulsive symptoms in ultra high risk subjects. Conclusion: Using a strict definition of obsessive-compulsive symptoms, we found relatively low prevalence rates of obsessive-compulsive symptoms and obsessive-compulsive disorder in patients with schizophrenia or related disorders; the rates are even lower than known rates of obsessive-compulsive symptoms and obsessive-compulsive disorder in the general population. Obsessive-compulsive symptoms rates in ultra high risk subjects are comparable to those in the general population. Further investigation of the predictive validity of obsessive-compulsive symptoms in ultra high risk subjects for developing psychosis is needed. Obsessive-compulsive symptoms either develop prior, during or after the onset of first episode psychosis.