Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder

Deborah Ahn-Robbins, MSc^a,e ; Nina H. Grootendorst-van Mil, MD, PhD^b ; Chin-Kuo Chang, PhD^a,c,d,e ; David Chandran, PhD^e ; Hitesh Shetty, PhD^e ; Jyoti Sanyal, PhD^e ; James H. MacCabe, FRCPsych, PhD^a,e ; Hannah Cohen, PhD^a,e ; Robert Stewart, MD^a,e ; Frederike Schirmbeck, PhD^f,g ; Lieuwe de Haan, MD, PhD^f,g,‡ ; Richard D. Hayes, PhD^a,e,‡

J Clin Psychiatry 2022;83(6):21m14010

ABSTRACT

Objective: Although frequently reported in psychosis, obsessive-compulsive symptoms (OCS) are often not recognized and thus undertreated. We aimed to estimate the prevalence of OCS and obsessive-compulsive disorder (OCD) in patients with schizophrenia, schizoaffective disorder, or bipolar disorder in clinical records and identify clinical associations of OCS co-occurrence.

Methods: Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre case register. The study population was restricted to individuals diagnosed with schizophrenia (ICD F20.x), schizoaffective disorder (ICD F25.x), or bipolar disorder (ICD F31.x) between 2007 and 2015. OCS and OCD were ascertained from structural fields and via Natural Language Processing software applied to free-text records. Clinical characteristics were obtained from Health of the Nation Outcome Scales for the analyses on associations between clinical characteristics and OCS/OCD status using logistic regressions with confounders considered.

Results: 22,551 cases of schizophrenia, schizoaffective disorder, or bipolar disorder were identified in the observation window. Among these, 5,179 (24.0%) were identified as having OCS (including an OCD diagnosis) and 2,574 (11.9%) specifically with comorbid OCD. OCS/OCD was associated with an increased likelihood of recorded aggressive behavior (OR = 1.18; 95% CI, 1.10–1.26), cognitive problems (OR = 1.21; 95% CI, 1.13–1.30), hallucinations and delusions (OR = 1.11; 95% CI, 1.04–1.20), and physical problems (OR = 1.17; 95% CI, 1.09–1.26).

Conclusions: OCS and OCD are frequently recorded for patients with schizophrenia, schizoaffective disorder, and bipolar disorder and are associated with more severe psychiatric clinical characteristics. Automated information extraction tools hold potential to improve recognition and treatment of co-occurring OCS/OCD for psychosis.

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