2002, Number 3
Salud Mental 2002; 25 (3)
Una aproximación al fenómeno esquizo-obsesivo
Lóyzaga C, Nicolini H, Apiquian R, Fresán A
PDF size: 432.54 Kb.
Although there is a controversy about the definition of schizo-obssesive phenomena, we propound as seen the revision of many medical and historical reports and the evaluation of patients who presents this phenomena, the next definition: “clinical phenomena characterized by temporal coexistence of both obsessive-compulsive and psychotic symptoms in a patient”.
This phenomena had been described in schizophrenia and OCD. The prevalence of this phenomena in both disorders is between 10 and 15%. The ECA study reported comorbidity between OCD and schizophrenia of 12.2% and comorbidity between OCD and schizophreniphorm disorder, 1.3%.
Nevertheless, in spite of the coexistence of obsessive-compulsive and psychotic symptoms had been observed since the early descriptions of schizophrenia and OCD, there are no studies about his clinical and neurobiological meaning.
There are two kinds of studies about the coexistence of obsessive and psychotic symptoms, some of them include patients with initial diagnoses of schizophrenia, who developed obsessive symptoms; the other kind of studies are conformed by patients with initial diagnoses of OCD, who developed psychotic symptoms on the course of his disorder.
There are three hypothesis for explain the obsessive and psychotic symptoms coexistence. One hypothesis explain this phenomena by comorbidity between OCD an schizophrenia, other propose that this patients represent specific subgroups of schizophrenia and OCD, and the last hypothesis propose a new clinical disorder. The coexistence between psychotic and obsessive-compulsive symptoms had been observed also in patients with schizophrenia who received clozapine. The treatment with this antipsychotic could cause or annoy obsessive symptoms. Some investigators propose that clozapine could cause this symptoms because his blockade in 5HT2c receptors.
The schizo-obsessive phenomena is frequent in the clinical practice, although it is not always recognized. However, these patients represent diagnostical and therapeutic difficulties, because both of the percentage of responders and the degree of intensity of response is minor than the patients with “pure diagnoses”. The phenomenological meaning of that coexistence is essential in the understanding of this clinical phenomena.
Currently, there is consensus that patients who present the schizoobsessive phenomena have more severe symptoms, bad response to treatment and worst prognosis.
In this review we present the two kinds of approach of the schizo-obsessive phenomena.
BAKER R, ROY KN, BARD JW, STEIGERD S, CHRIST M, SCHOOLER N: Emergence of obsessive-compulsive symptoms and shizophrenia. J Clin Psychiatry, 53:439-442, 1992.
BAKER RW, AMES D, UMBRICHT DS, CHENGAPPA KN, SCHOOLER N: Obsessive-compulsive symptoms in schizophrenia: a comparison of olanzapine and placebo. Psychopharm Bull, 32(1):89-93, 1996.
BALLERINI A, STANGHELLIMIE G: Phenomenological questions about obsessions. Psychopathology, 22:315-319, 1989.
BEARMAN I, SAPERS B, CHANG HH, LOSONZY M, SCHMILDER J, GREEN A: Treatment of obsessivecompulsive symptoms in schizophrenic patients with clorimipramine. J Clin Psychopharmacol, 15:206-210, 1995.
BERRIOS G: The history of mental symptoms. Cambridge University Press, 1996.
CHANG HH, BERMAN I: Treatment issues for patients with schizophrenia who have obsessive-compulsive symptoms. Psychiatric Annals, 29(9):529-532, 1999.
DURSEN MJ, REVELEY M: Obsessive-compulsive symptoms and clozapine. Br J Psychiatry, 160:267-268, 1995.
EALES MJ, LAYENI AO: Exacerbation of obsessivecompulsive symptoms in associate with clozapine. Br J Psychiatry, 164:687-688, 1994.
EISEN JL, RASMUSSEN S: Clinical and epidemiological findings of significance to neuropharmacological trials in OCD. Psychopharmacology Bull, 24(3):466-477, 1988.
FENTON WS, MCGLASHAN TH: The long term outcome of obsessive-compulsive disorder with psychotic features. J Ner Met Dis, 187:760-766, 1992.
FENTON WS, MCGLASHAN TH: The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry, 143:437-441, 1986.
HWANG M, HOLLANDER: Schizo-obsessive disorders. Psychiatric Annals, 23(7):396-401, 1993.
HWANG M, OPLER L: Management of schizophrenia with obsessive-compulsive disorders. Psychiatric Annals, 30(1):23-28, 2000.
HWANG MY, OPLER LA: Schizophrenia with obsessivecompulsive features: assessment and treatment. Psychiatric Annals, 24(9): 468-472, 1994.
INGRAM JE: Obsessional illness in mental hospital patients. J Ment Sci, 107:382-402, 1961.
INSEL TR, AKISKAL HS: Obsessive-compulsive disorder with psychotic features a phenomenological analysis. Am J Psychiatry, 143:1527-1533, 1986.
JENIKE M, BAER L, MINICHELO W, SCHUARTZ CE, CAREY RJ: Concomitant obsessive-compulsive disorder and schizotypal personality disorder. Am J Psychiatry, 143(4):530-532, 1986.
KARNO M, GOLDING JM, SORESON SP, BURNAM MA: The epidemiology of obsessive-compulsive disorder in five U.S. communities. Arch Gen Psychiatry, 45:1094-1099, 1988.
LYKOURAS L, ZERVAS IM, GOURNELLIS R, MALLIORI M, RAVAVILAS A: Olanzapine and obsessivecompulsive symptoms. European Neuropsychopharmachol, 10(5):385-387, 2000.
PARTA LA: More on obsessive-compulsive symptoms and clozapine. J Clin Psychiatry, 55(7):312, 1994.
PATEL B, TANDOM R: Development of obsessivecompulsive symptoms during clozapine treatment. Am J Psychiatry, 150(5):873, 1993.
PATIL VJ: Development of transit obsessive-compulsive symptoms during clozapine treatment (letter to editor). J Clin Psychiatry, 149(2):272, 1992.
POYOROVSKY M, DORFMAN-ERGOT P, HERESH H, MUNITZ H, TOLLEFSON GD, WEIZMAN A: Beneficial effect of olanzapine in schizophrenic patients with obsessive-compulsive symptoms. Int Clin Psychopharmachol, 15(39):169-173, 2000.
ROSEN R: The clinical significance of obsessions in schizophrenia. J Ment Sci, 103:778-785, 1957.
SOBIN C, WEILLER C, CAVIGAN C, HAIMAN C, KARAYIORGU M: Evidence of a schizotypy in OCD. J Psychiatry Research, 34:15-24, 2000.
SOLYMON L, DINICOLA VF, SOOKMAN D, LUCHINS D: Is there an obsessive psychosis? An etiological and pronostical factors of an atypical form of obsessivecompulsive neurosis. Can J Psychiatry, 30:372-379, 1985.