The schizo-obsessive spectrum: Mapping clinical phenotypes, neurobiological mechanisms, and treatment considerations in first-episode psychosis - An updated systematic review - 30/11/25
, Giovanni Martinotti b, Giuseppe Maina a, cAbstract |
Objectives |
Obsessive-compulsive symptoms (OCS) represent a prevalent comorbidity in first-episode psychosis (FEP) with significant implications for clinical presentation and treatment outcomes. This systematic review examines OCS prevalence, clinical characteristics, neurobiological correlates, and treatment approaches in FEP populations.
Methods |
Following PRISMA guidelines, we searched PubMed, Embase, PsycINFO, Web of Science, and Cochrane databases from inception to May 2025. Studies examining OCS in FEP patients (≤5 years from first episode) were included. Meta-analysis used random-effects models with Freeman-Tukey transformation. Quality assessment employed Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
Results |
Twenty-one studies encompassing 3989 participants were included. Meta-analysis revealed clinically significant OCS in 26.8 % (95 % CI: 18.2–37.1 %) of FEP patients and formal OCD diagnosis in 8.3 % (95 % CI: 6.1–11.2 %)—representing 3–4 fold elevations versus general population. OCS typically emerged 8–12 months before psychotic symptoms in 65 % of patients. Comorbid OCS patients demonstrated significantly higher positive symptom severity, depression scores, and functional impairment. Neuroimaging identified frontostriatothalamic abnormalities, including reduced orbitofrontal (Cohen's d: 0.48) and anterior cingulate cortex volume (Cohen's d: 0.43). Social cognitive deficits, particularly theory of mind impairments (58.3 % vs 71.2 % accuracy, p = 0.024), were enhanced in OCS patients. Treatment challenges included antipsychotic-induced OCS (38.9 % with clozapine vs 20.1 % olanzapine) and SSRI-related psychotic symptom exacerbation (16.7 %).
Conclusions |
OCS affect one in four FEP patients, supporting a distinct “schizo-obsessive” subtype with specific neurobiological abnormalities and treatment considerations. Routine screening and integrated management protocols are essential for optimizing outcomes.
Le texte complet de cet article est disponible en PDF.Highlights |
• | High prevalence of obsessive-compulsive symptoms in first-episode psychosis (26.8 % pooled prevalence), representing a 3.6-fold increased risk compared to general population. |
• | Temporal analysis reveals that 65 % of patients develop obsessive-compulsive symptoms before or concurrent with psychotic symptoms, typically emerging 8–12 months prior to frank psychosis. |
• | Neuroimaging evidence demonstrates shared frontostriatothalamic circuit abnormalities in orbitofrontal cortex, anterior cingulate cortex, and striatal regions underlying the “schizo-obsessive” phenotype. |
• | Treatment paradoxes identified: clozapine and olanzapine significantly increase obsessive-compulsive symptoms (38.9 % vs 20–23 % with other antipsychotics), while SSRIs risk psychotic symptom exacerbation in 16.7 % of patients. |
• | Patients with comorbid obsessive-compulsive symptoms show enhanced social cognitive deficits, longer hospitalizations, and require higher antipsychotic doses, necessitating specialized integrated treatment approaches. |
Keywords : First-episode psychosis, Obsessive-compulsive symptoms, Schizo-obsessive subtype, Neurobiological mechanisms, Early intervention
Plan
Vol 97
P. 146-160 - novembre 2025 Retour au numéro
Article précédent
- Effects of mobile app-based interventions on quality of life in patients with breast cancer: a systematic review and meta-analysis
- Ju Hyun Ahn, Myoungsuk Kim
- A guideline-based perspective on neurostimulation in treatment-resistant obsessive-compulsive disorder: An international overview
- Nadine D. Wolf, Martin Jakobs, R. Christian Wolf
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?