Obsessive compulsive symptoms in Schizophrenia: the prevalence, associated factors and clinical outcomes in University Malaya Medical Center / Ng Boon Seng

Ng , Boon Seng (2016) Obsessive compulsive symptoms in Schizophrenia: the prevalence, associated factors and clinical outcomes in University Malaya Medical Center / Ng Boon Seng. Masters thesis, University of Malaya.

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Abstract

There is a growing interest on the impact of comorbid obsessive compulsive symptoms on the course and severity of Schizophrenia in recent years. However, to date, there is no study on the prevalence of obsessive compulsive symptoms in Schizophrenia in Malaysia, and no study was done on their impacts. Existing literatures elsewhere showed conflicting evidences on the clinical outcomes of this comorbidity. In line with holistic care for people with chronic mental illness, recognition of the impacts of OCS on Schizophrenia would help to reduce the devastating burden on the sufferer and the family. Objectives This study is to determine the prevalence of obsessive compulsive symptoms in Schizophrenia patients receiving their treatment in University Malaya Medical Centre and the clinical outcomes of the comorbidity. Methodology This is a cross sectional study conducted in Psychiatric Clinic, UMMC from August 2014 until July 2015. A total of 220 participants were recruited for this study. Participants’ demographic data were obtained and completed Structured Clinical Interview for Positive and Negative Syndrome Scale (SCI-PANSS), Yale-Brown Obsessive Compulsive Scale Symptoms Checklist (YBOCS-CL), (Yale-Brown Obsessive Compulsive Scale) YBOCS, Calgary Depression Scale Schizophrenia (CDSS), Columbia Suicide Severity Rating Scale (C-SSRS) and World Health Organization Quality of Life Brief Version (Malay) (WHOQOL BREF Malay Version). Participants were further divided into Schizophrenia with obsessive compulsive symptoms and without obsessive compulsive symptoms. Comparison on their demographic data and clinical outcomes were analysed using statistical analysis methods in Statistical Package for Social Sciences (SPSS) Version 22.0. Results The prevalence of obsessive compulsive symptoms in the participants was 21.8% (N = 48) when YBOCS score cut off point of 8 and above were taken as clinically significant OCS. There were no significant difference in age, gender, race, marital status, education level, employment, family history of any mental illness, duration of illness, class of antipsychotics prescribed and other other prescribed psychotropics. However, significantly higher number of patients with obsessive compulsive symptoms were taking Clozapine (p = 0.023) and antidepressants (p = 0.013). In term of clinical variables, Schizophrenia patients with OCS showed more severe positive (p < 0.001) and general symptoms (P = 0.001) of Schizophrenia, higher depressive symptoms (p = 0.013), higher suicidality (p < 0.001) and more hospitalization (p = 0.044) after adjusting for duration of illness and used of clozapine. No significant difference in term of negative symptoms and quality of life. Correlation analysis showed small positive correlation between obsession and compulsion with delusion, hallucinatory behaviours, suspiciousness and stereotypies behaviours. Discussion From this study, the prevalence of Obsessive Compulsive Symptoms in Schizophrenia was lower compared with that was found in meta analysis. Various methodological differences may be explained this discrepancy. Clozapine was consistently found to be associated with presence of obsessive compulsive symptoms in Schizophrenia. Comorbid Schizophrenia with obsessive compulsive symptoms were associated with more severe psychopathology, higher depressive symptoms and higher suicidality after adjusting for confounders which highlight the worse clinical course of the illness according to double jeapordy effects of comorbidity and the possible existence of Schizo-obsessive disorder. Conclusion High prevalence of obsessive compulsive symptoms in Schizophrenia was found in this study in line with previous research findings. The comorbid was shown to have more severe psychopathology and higher suicidality. Recognition of obsessive compulsive symptoms in Schizophrenia and early initiation of effective treatment may be able to reduce the burden for people with chronic mental illness. Future research may be recommended to focused on the treatment strategies for this comorbidity and the standardized criteria for obsessive compulsive symptoms should be made available.

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