Schizo-obsessive disorderSchizo-obsessive disorder? A new subtype of ? A new subtype of

schizophreniaschizophrenia

Dr J RomainDr J Romain

Dr YagoubDr Yagoub

Possible definitionPossible definition

Patients who have OCD and Patients who have OCD and schizophrenia and whose obsessions and schizophrenia and whose obsessions and compulsions are unrelated to the content compulsions are unrelated to the content of their psychosis.of their psychosis.

Controversy centres on whether there is a Controversy centres on whether there is a continuum or overlap in psychopathology continuum or overlap in psychopathology between these entities that some authors between these entities that some authors have called "schizo-obsessive disorder."have called "schizo-obsessive disorder."

Why do we care?Why do we care?

Schizo-obsessive patients have a more Schizo-obsessive patients have a more chronic course, a greater frequency of chronic course, a greater frequency of social and occupational impairment, and social and occupational impairment, and show poor treatment response and a poor show poor treatment response and a poor long-term outcome. long-term outcome.

ResearchResearch

A study by Michael Y. Hwang, M.D in A study by Michael Y. Hwang, M.D in journal of neuropsychiatry and clinical journal of neuropsychiatry and clinical neurosciences 12:91-94, Feb 2000neurosciences 12:91-94, Feb 2000

A pilot blind controlled study, 20ptsA pilot blind controlled study, 20ptsCompared characteristics of obsessive-Compared characteristics of obsessive-

compulsive (OC) schizophrenic patients compulsive (OC) schizophrenic patients and a matched non-OC schizophrenic and a matched non-OC schizophrenic control group control group

Results- Schizo-obessive groupResults- Schizo-obessive groupSignificantly longer periods of Significantly longer periods of

hospitalisation hospitalisation They took more adjunctive medications They took more adjunctive medications

such as benzodiazepines and such as benzodiazepines and antidepressantsantidepressants

They had a poorer clinical course with They had a poorer clinical course with lower levels of functioning, especially in lower levels of functioning, especially in terms of "self-care" and "social terms of "self-care" and "social competency” competency”

Results for Schizo-obsessive groupResults for Schizo-obsessive group

Higher rate of negative symptoms Higher rate of negative symptoms Higher level of general psychopathology Higher level of general psychopathology

using the Wisconsin Card Sorting Test using the Wisconsin Card Sorting Test (WCST) and MMSE. (WCST) and MMSE.

No difference in positive symptoms, No difference in positive symptoms, anergia, depression or thought anergia, depression or thought disturbance factors.disturbance factors.

Summary of StudySummary of Study

Findings indicate that schizo-obsessive Findings indicate that schizo-obsessive patients may possess a unique clinical and patients may possess a unique clinical and neuropsychological profile within the neuropsychological profile within the schizophrenic spectrum schizophrenic spectrum

Possible treatment RegimesPossible treatment Regimes

Treatment with serotonin reuptake Treatment with serotonin reuptake blockers, added to a neuroleptic, is found blockers, added to a neuroleptic, is found to be efficacious in the treatment of to be efficacious in the treatment of obsessions and compulsions and to obsessions and compulsions and to improve overall schizophrenic symptoms. improve overall schizophrenic symptoms.

DiscussionDiscussion

Both patients clearly exhibit hoarding as Both patients clearly exhibit hoarding as their obsessional symptomtheir obsessional symptom

Hoarding is being considered as a part of Hoarding is being considered as a part of OC spectrum in its own right for DSM-VOC spectrum in its own right for DSM-V

Recent literature suggests that the core Recent literature suggests that the core symptoms, associated features, and symptoms, associated features, and neurobiological abnormalities of hoarding neurobiological abnormalities of hoarding differ from OCD.differ from OCD.

Other Possible DiagnosesOther Possible Diagnoses

OC Schizophrenia?OC Schizophrenia?Compulsive hoarding syndrome with some Compulsive hoarding syndrome with some

psychotic symptoms? psychotic symptoms?

Questions?Questions?