Francesca Paglia

The clinical meaning of obsessive-compulsive symptoms in bipolar disorder and schizophrenia.

The rate of co-morbid obsessivecompulsive disorder (OCD) with both bipolar and schizophrenia spectrum disorders is high. The lifetime prevalence of bipolar disorder (BD) in OCD patients is up to 21.5% and almost 50% of OCD patients have cyclothimic traits (D’Ambriosio et al., 2010). Co-morbid OCD is diagnosed in 8–32% of patients with schizophrenia (SCZ) and in up to 35% of patients with schizotypal personality disorder (de Haan et al., 2013). On one hand, BD-OCD is associated with poorer functioning as compared to ‘pure’ BD or ‘pure’ OCD (Amerio et al., 2014). On the other hand the impact of OC symptoms (OCS) on functioning in SCZ might depend on their severity: OCS might have an improving effect while a fullblown OCD might have a worsening one (de Haan et al., 2013). In line with these findings, preliminary results of our recent study have showed a gradual transition from an improving effect (mild OCS) to a worsening one (moderate–severe OCS) on functioning in SCZ subjects. OC symptoms are mediated by fronto-striato-thalamic circuits which have a crucial role in the regulation of daily master routines and sub-routines. Since these circuits can also be involved in the pathogenesis of BD and SCZ, OCS may have different clinical meanings in these disorders:

Risk factors for incident depression in patients at first acute coronary syndrome

The association between depression and acute coronary syndrome (ACS) is well-established and the first seems to impact meaningfully on cardiac prognosis. Nonetheless only a few studies have evaluated the relationship between incident depression, defined as new cases in patients with no history of depression, and ACS. Therefore the aim of this study is to analyse the risk factors of incident depression in a sample of patients who were presenting their first ACS. 304 consecutive patients were recruited. The presence of major (MD) and minor (md) depression was assessed with the Primary Care Evaluation of Mental Disorders (PRIME-MD), whereas its severity was evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected both at baseline and at 1, 2, 4, 6, 9 and 12 month follow ups. Out of 304 subjects (80.6% males), MD was diagnosed in 15 (4.9%) and md in 25 patients (8.2%). At baseline risk factors for a post-ACS depressive disorder were being women (MD only), widowed (md only) and having mild anhedonic depressive symptoms few days after the ACS. Clinicians should keep in mind these variables when facing a patient at his/her first ACS, given the detrimental effect of depression on cardiac prognosis.

Obsessive–compulsive symptoms interact with disorganization in influencing social functioning in schizophrenia

OBJECTIVE Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptoms (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently. METHOD Seventy-five patients affected by schizophrenia were administered the Structured Clinical Interview for DSM-IV Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment. The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high OCS group). RESULTS In both groups, the effect of OCS on functioning was not mediated by their effect on positive, negative or disorganization symptoms. Conversely, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at high levels of disorganization. CONCLUSION Data suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS.

Obsessive-Compulsive Symptoms in Schizophrenia and in Obsessive-Compulsive Disorder: Differences and Similarities.

Introduction: A growing literature suggests that obsessive-compulsive (OC) phenomena represent a distinct dimension in schizophrenia, independent of nuclear psychotic symptoms. Nevertheless, the OC psychopathologic profile in schizophrenia, compared with “pure” obsessive-compulsive disorder (OCD), has not yet been investigated extensively. This study investigated the clinical features of the OC dimension in patients with schizophrenia compared with patients with pure OCD. Methods: The main psychopathologic features of obsessions and compulsions were rated in 35 patients with schizophrenia and 31 patients with OCD, using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale, and the Leyton Obsessional Inventory. Results: OC phenomena were indistinguishable in terms of their severity, resistance, interference, and control in both groups. However, patients with OCD showed higher rates of aggressive, contamination-related, sexual, and somatic themes; moreover, in the group with schizophrenia, a positive relationship was found between washing compulsions and delusions and between hoarding obsessions and delusions. Conclusions: These results indicate that patients with schizophrenia exhibit a narrower range of obsessive content compared with patients with OCD; in addition, OC and delusional themes tend to be related in schizophrenia as a unique symptomatic phenomenon.

Obsessive–compulsive symptom severity in schizophrenia: a Janus Bifrons effect on functioning

The impact of obsessive–compulsive symptoms on functioning in schizophrenia is still debated. This study investigated the relationship between OC symptoms and functioning along a severity gradient of obsessive–compulsive dimension. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive–Compulsive Scale and the Social and Occupational Functioning Assessment Scale. The relationship between functioning and obsessive–compulsive dimension was described by a reverse U-shaped curve; functioning was positively related to the presence of mild obsessive–compulsive symptoms and inversely related to moderate and severe symptoms, after controlling for the severity of positive, negative, disorganization and general psychopathological symptoms. The role of obsessive–compulsive symptoms on social functioning in schizophrenia occurs along a severity continuum with a gradual transition from a positive correlation (from absent to mild symptoms) to an inverse correlation (for symptoms ranging from moderate to severe) and independently from schizophrenia symptom dimensions.