Obsessive-compulsive disorder with psychotic features: psychopathological and personological aspects

Aim. The aims of this study are to analyze psychopathological relations between obsessive-compulsive and psychotic symptoms in a group of patients with obsessive-compulsive disorder (OCD), and to verify if the obsessive subgroup with psychotic features can be considered as a distinct OCD subtype. Methods. The study sample included 68 patients with OCD who were divided into two different groups (OCD with and without psychotic features). All subjects completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Scale for the Assessment of Positive Symptoms (SAPS), the Hamilton Depression Rating Scale (HDRS), and the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Result. Twenty subjects (29.4%) were affected by OCD with psychotic features. They were characterized by an earlier onset of obsessive illness (p<0.05), a more frequently chronic course (p<0.01), an "atypical" obsessive-compulsive symptomatology (with poor insight and anxiety) (p<0.001), higher levels of depression (p<0.05), and a higher prevalence of schizotypal personality disorder (p<0.01). Discussion. Patients affected by OCD with psychotic symptoms appear to be a distinct subtype of obsessive-compulsive disorder, characterized by a set of specific psychopathological and personological features. However, the finding that these subjects have a higher prevalence of schizotypal personality disorder seems to suggest that they can be considered as a peculiar clinical subset belonging to the schizophrenia-spectrum disorders rather than a group of obsessive individuals placed on the most serious clinical extreme of the OCD spectrum.