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Created by :
Endah Fitri

Dr.Sabar P. Siregar, Sp.KJ



Journal : Relationship between psychotic and obsessive

compulsive symptoms in schizophrenia
The presence of obsessive compulsive symptoms (OCSs) in schizophrenia was
recognized as early as the first descriptions of the illness. The association between OCSs
and schizophrenia have defined their co-occurrence in terms of comorbidity and
compared schizophrenia patients separated into groups according to whether they
presented OCSs or not, or less often, OCD patients grouped according to the presence of
psychotic symptoms.
Because the two disorders involve similar functional brain networks (e.g., frontal
cortex, basal ganglia) and similar neurotransmission systems (e.g., dopamine, serotonin),
it has been suggested that some patients could even constitute a particular diagnostic
subcategory called schizo-obsessive.
The presence of OCSs before the onset of schizophrenia could also constitute a
prodromic sign, although there are some data to suggest that at the beginning of the
illness, OCSs have a protective effect against some psychotic symptoms. Positive
symptoms that predominate in the early stages of the illness progressively decrease so as
negative symptoms predominate later in the chronic stage.
The presence of OCSs in general is associated with positive symptoms and
emotional and other studies found no differences between patient groups. A few studies
have analyzed the differences between schizophrenia patients with and without OCSs
using the subscores from the Scales for Assessment of Positive and Negative Symptoms
(SAPS-SANS). OCSs can be associated with less severe thought disordersand higher
levels of delusions. Poyurovsky et (1999) have also reported that OCSs are associated
with lower level of affective blunting, whereas Nechmad et al. found an aggravation of
these symptoms.
Disorganization is related to Obsessions, but this association is dependent on
Bizarre delusions (it is no longer significant when this dimension is controlled for).
Besides, there is a stronger relationship between Bizarre delusions and Obsessions. This
observation is consistent with the view that delusions and obsessionsreflect
manifestations of the same mechanism and are distinguishable on the basis of the level of
insight the patient displays. This mechanism could ell be expressed as over-valued ideas

lying on a continuum of obsessional doubts to delusional certainty. On the other hand, the
link found with Disorganization on the simple regression could well be related to the
level of insight that has been associated with thought disorders and disorganization.
Bizarre delusions are also related to Compulsions, but this link is masked by


Reciprocally, Auditory





Compulsions, but this link is masked by Bizarre delusions. As for Bizarre delusions an
Obsessions, one may speculate that there is also a common mechanismin Auditory
hallucinations and Compulsions. In fact, compulsions are often conceived as an acting
out in response to an anxiogenic environment, i.e., obsessions. Similarly, hallucination
could be viewed as a perceptual acting out in response to anxiogenic thoughts, i.e.,
delusions. Thus hallucinations and compulsions may both reflect a decrease capacity to
inhibit behaviors or thoughts. This viewis somewhat supported by the recent finding that
reality distortion symptoms and sensation seeking or impulsivity share common
neurophysiological mechanisms.
Specific relationships between the symptom dimensions of schizophrenia and
OCSs suggesting similar underlying mechanisms, e.g., delusion and obsession both
related to over-valued ideas, or hallucinations and compulsions related to disinhibition.
By this view, OCSs might be better conceived as an integral part of the expression of
schizophrenia rather than in terms of comorbidity.