Can obsessions drive you mad? Longitudinal evidence that obsessive-compulsive symptoms worsen the outcome of early psychotic experiences

Authors

  • F. Van Dael,

    1. Department of Neuropsychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
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  • J. van Os,

    1. Department of Neuropsychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
    2. King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, Denmark Hill, London, UK
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  • R. de Graaf,

    1. Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht
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  • M. ten Have,

    1. Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht
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  • L. Krabbendam,

    1. Centre Brain and Learning, Department of Psychology and Education, VU University, Amsterdam, the Netherlands
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  • I. Myin-Germeys

    1. Department of Neuropsychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
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Inez Myin-Germeys, Department of Psychiatry and Neuropsychology, Maastricht, University, PO Box 616 (VIJV), 6200 MD Maastricht, the Netherlands.
E-mail: i.germeys@sp.unimaas.nl

Abstract

Van Dael F, van Os J, de Graaf R, ten Have M, Krabbendam L, Myin-Germeys I. Can obsessions drive you mad? Longitudinal evidence that obsessive-compulsive symptoms worsen the outcome of early psychotic experiences.

Objective:  Although there is substantial comorbidity between psychotic disorder and obsessive-compulsive disorder (OCD), little is known about how these clinical phenotypes, and their subclinical extended phenotypes, covary and impact on each other over time. This study examined cross-sectional and longitudinal associations between both (extended) phenotypes in the general population.

Method:  Data were obtained from the three waves of the NEMESIS-study. A representative population sample of 7076 participants were assessed using the composite international diagnostic interview (CIDI) at baseline (T0), 1 year later at T1 and again 2 years later at T2.

Results:  At T0, a lifetime diagnosis of psychotic disorder was present in 1.5% of the entire sample, in 11.5% of the people with any OC symptom and in 23.0% of individuals diagnosed with OCD. OC symptoms at T0 predicted incident psychotic symptoms at T2. Similarly, T0 psychotic symptoms predicted T2 OC symptoms. The likelihood of persistence of psychotic symptoms or transition to psychotic disorder was higher if early psychosis was accompanied by co-occurring OC symptoms, but not the other way around.

Conclusion:  OCD and the psychosis phenotype cluster together and predict each other at (sub)clinical level. The co-occurrence of subclinical OC and psychosis may facilitate the formation of a more ‘toxic’ form of persistent psychosis.

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