Yilmaz FB, Uzun UE, Erkiran M
A case report: schizophrenia with Obsessive compulsive disorder
The prevalence of Obsessive-compulsive symptoms is 2.5%-64% and the comorbidity of Obsessive compulsive disorder’s prevalence is 0%-37.5% in schizophrenia. This broad scale found in previous researches is because of methodological differences. In a recent meta-analysis, the prevalence of OCD in schizophrenia was estimated to be 12.1%, a rate considerably higher than in the general population (2%-3%). Obsessive-compulsive symptoms, in schizophrenia patients, aggravate the psychopathology and demolish especially executive and cognitive functions. Compared with schizophrenia patients, schizo-obsessive patients exhibit an earlier age of onset, more depressive symptoms and suicide attempts, increased rates of hospitalization, decreased likelihood of being employed or married, lower quality of life and greater disability. Authorities suggest that this comorbidity was related with similar anatomic structure, neurological pathways and neurotransmitters, therefore differential diagnosis of these depends on insight. Diagnostic dilemma and distinction among the delusion, obsession and overvalued thoughts is challenging after allowing the OCD with “poor insight” in The Diagnostic and Statistical Manual of Mental Disorders (DSM). A 34-year-old male presented with fear of death, offensiveness and skepticism was thinking he would be poisoned or murdered. The patient was not able to cope with the idea of to be killed and was in need to be proved that he will not be killed or injured. He could not be sure about whether he has been told the truth about him. He was delusional and had compulsive behaviors through his delusions. After patient’s psychotic symptoms have regressed with injection treatment, we gave to the patient 20 mg/day olanzapine and his compulsive symptoms decreased. However, four days later his compulsive and psychotic symptoms repeated and we dropped Olanzapine dosage and added 20 mg/day aripiprazole. Patients have become more aggressive and defensive although his compulsive symptoms were decreased with aripiprazole treatment. Accurate diagnosis has prognostic and treatment implications, given that current treatments for schizophrenia and OCD differ, and first-line medications for one disorder can exacerbate the symptoms of the other. Antipsychotics can exacerbate obsessive-compulsive symptoms, and SSRIs may exacerbate psychosis.