OCS common in patients at high risk for psychosis

By Mark Cowen, Senior MedWire Reporter

Obsessive-compulsive symptoms (OCS) are common in patients at high risk for psychosis and are associated with an increased risk for suicidal ideation, US study results show.

In a study of 20 youths deemed to be at high clinical risk for psychosis, 30% met criteria for obsessive-compulsive disorder and 60% had at least one OCS, as measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

All patients with OCS endorsed obsessions with an aggressive content, with 83% reporting themes of self-harm or harming others. Obsessions with "horrific" images and impulsive behavior were also common.

Furthermore, 55% of patients had a history of suicidal ideation, as determined through chart review, and 30% had current suicidal ideation, as assessed using an item from the Beck Depression Inventory (BDI).

OCS severity was greater among patients with either a history of suicidal ideation or current suicidal ideation, with average Y-BOCS scores of 12.9 and 16.3, respectively, compared with 4.6 and 6.1, respectively, among those without suicidal ideation.

Patients with OCS also had greater levels of depression than those without OCS, with total BDI scores of 15.2 versus 7.3, and more social impairment, with Social Adjustment Scale-Self-Report scores of 2.6 versus 2.0.

The researchers note that OCS severity was positively associated with depressive symptoms and social impairment. However, neither OCS presence nor severity were associated with positive symptoms, as assessed using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms.

"This study shows that aggressive obsessions and suicidal ideation are prevalent and interrelated in clinical high risk patients, which indicates that clinical high risk patients should be routinely assessed for depression, aggressive thoughts and suicidal ideation," conclude Jordan DeVylder (Columbia University School of Social Work, New York) and team in Schizophrenia Research.

They add: "These can be targeted in high risk patients through medications other than antipsychotics, and with psychosocial treatments such as cognitive-behavioral therapy and suicide prevention. Early detection of psychotic symptoms through community outreach may reduce suicidal ideation by facilitating early access to treatment."

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