Co-morbid obsessive-compulsive symptoms in psychotic disorders: Insight into symptom variability and interaction

Frederike Schirmbeck1, Carin Meijer1, Lieuwe de haan1, GROUP Investigators; 1Academisch Medisch Centrum, University of Amsterdam

Background: A frequent co-morbidity in psychotic disorders are obsessive-compulsive symptoms (OCS), which are reported by more than 20% of patients and are associated with additional impairment and poorer prognosis. Recent prospective studies revealed a high variability of co-morbid OCS, with symptom remission, fluctuation or de novo occurrence. However, findings were limited by long intervals between assessments, allowing no statements on symptom interaction and leaving possible underlying mechanisms unresolved. We aim to investigate the course and relationship between psychotic, obsessive-compulsive and depressive symptoms and the influence of environmental and individual factors. Method: 60 patients from the large Genetic Risk and Outcome of Psychosis Project (GROUP) were followed up over a 6 months period with monthly assessments including psychopathology (symptoms of psychosis, OCS and depression), life-events, perceived stress and coping. Linear mixed model analyses were calculated to assess associations between symptom clusters and the effect of life-events/stress and coping strategies. Results: Within-subject changes in OCS were significantly associated with changes in psychotic and depressive symptoms. The experience of recent life events significantly predicted higher psychopathology in general, whereas avoidance focused coping significantly added to the prediction of co-occurring OCS severity. Conclusions: These findings confirm within-subject variation in the course of OCS severity in patients with psychotic disorders. Findings suggest that co-occurring higher severity of OCS, psychotic and depressive symptoms might partly be explained by the experience of stressfull life-events. The negative effect of dysfunctional coping strategies on the course of co-morbid OCS suggest that they should be targeted during treatment.

Topic Area: Comorbid Conditions

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