مقاله انگلیسی رایگان در مورد اسکیزوفرنی و اختلال وسواس فکری-جبری – MDPI 2024

Abstract

Schizophrenia (SCZ) and obsessive–compulsive disorder (OCD) typically have distinct diagnostic criteria and treatment approaches. SCZ is characterized by delusions, hallucinations, disorganized speech, and cognitive impairments, while OCD involves persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The co-occurrence of these disorders increases clinical complexity and poses significant challenges for diagnosis and treatment. Epidemiological studies indicate a significant overlap, with prevalence rates of comorbid OCD in SCZ patients ranging from 12% to 25%, which is higher than in the general population. Etiological hypotheses suggest shared genetic, neurobiological, and environmental factors, with genetic studies identifying common loci and pathways, such as glutamatergic and dopaminergic systems. Neuroimaging studies reveal both overlapping and distinct neural abnormalities, indicating shared and unique neurobiological substrates. Environmental factors, like early life stressors and urbanicity, also contribute to the comorbidity. The overlapping clinical features of both disorders complicate diagnosis. Treatment approaches include combining SSRIs with antipsychotics and cognitive behavioral therapy (CBT). The complexity of SCZ and OCD comorbidity underscores the need for a dimensional, spectrum-based perspective on psychiatric disorders, alongside traditional categorical approaches, to improve diagnosis and treatment outcomes.

Introduction

Schizophrenia (SCZ) and obsessive–compulsive disorder (OCD) are both debilitating psychiatric conditions, each with distinct diagnostic criteria and treatment approaches. SCZ, as defined in the DSM-5 [1], is a chronic mental disorder characterized by a range of symptoms, including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and cognitive impairments [2,3]. These symptoms must be present for a significant portion of time during a one-month period, with continuous signs of disturbance persisting for at least six months, significantly impacting various areas of functioning, such as work, interpersonal relations, and self-care [1]. SCZ’s influence on everyday life can be profound, often leading to significant disabilities and incomplete recovery for many individuals [4]. Those with relatively positive outcomes still contend with social isolation, the stigma associated with the disorder, and fewer opportunities to build close relationships. Unemployment rates are exceptionally high among those with SCZ [5,6]. Common issues, such as unhealthy diet, weight gain, smoking, and substance abuse, contribute to a decreased life expectancy, shortening it by about 13 to 15 years [5,6]. Moreover, the risk of suicide over a lifetime for individuals with SCZ is estimated to be between 5% and 10% [7].

OCD, on the other hand, involves persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing the anxiety generated by these thoughts [8,9]. Obsessions are defined as recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, causing marked anxiety or distress. Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules and as being time-consuming or causing significant distress or impairment in important areas of functioning [1]. OCD profoundly affects daily life, causing significant distress and impairment. Individuals with OCD often devote excessive time to their obsessions and compulsions, disrupting work, education, and personal relationships [10]. The disorder severely limits social and occupational functioning, with studies indicating that up to 60% of those with OCD experience moderate to severe daily impairment [10,11]. The quality of life for these individuals is considerably lower than that of the general population, with high comorbidity rates for depression and anxiety [9,10]. Regarding mortality, OCD is linked to a heightened risk of suicide; the lifetime prevalence of suicidal thoughts among individuals with OCD ranges from 36% to 63%, and the risk of suicide attempts is between 10% and 27% [12].

Discussion

The literature shows various overlapping factors between SCZ and OCD. Both disorders are fundamental pathological entities in psychiatry, due to their prevalence and the burden they impose [11,15,16,17,18]. They share a complex etiological and pathophysiological component, comprising genetic, environmental, and neurostructural elements [23,38,54,82]. Our review highlights how some of these elements demonstrate the following commonalities: shared genetic factors, environmental circumstances that may underlie both disorders, and shared neurostructural alterations. It is important, therefore, to consider studies that demonstrate common etiological and clinical characteristics. For example, a recent study using integrated bioinformatic analysis has highlighted shared genetic and molecular mechanisms between SCZ and OCD [119].

Due to the shared features and differing elements between the two disorders, treatment remains challenging. The pharmacological profiles of treatments for SCZ and OCD differ significantly, with SGAs potentially inducing obsessive symptoms by antagonizing the 5HT2A receptor [90]. Hence, further studies are necessary to determine the best treatment for OCSs in patients with schizophrenia. Preliminary recommendations include combining an antipsychotic with an SSRI, such as escitalopram [95].