Obsessive Compulsive Disorder with Psychotic Features - a Case Report

The relationship between obsessive compulsive disorder and psychotic state is intriguing. Early German authorities such as Bleuler shared the view put forward by Westphal that the entire obsessive compulsive syndrome is a variant or prodrome of Schizophrenia (Bleuler 1951). Many follow-up studies of patients who received an initial diagnosis of obsessive compulsive disorder have found variable incidence of psychosis ranging from 0-12% (Akhtar et al. 1975, Bratfos 1970, Ingram 1961, Kringlen 1965, Pollit 1957, Rosenberg 1968). But whether these psychotic states are essentially schizophrenic in nature is doubtful on applying the current diagnostic concepts. Roth (1978) has distinguished the psychotic state developing in patients with long standing obsessive compulsive disorder from nuclear Schizophrenia. Recently, Insel and Akiskal 1986) have proposed that although psychotic manifestations in obsessive compulsive disorder could represent a pre-existing Schizophrenic process, Schizophrenic deterioration in well-established obsessive compulsive disorder is rare and superimposed psychosis in obsessive compulsive disorder is either a paranoid state or a mood disorder. Based on their clinical evidence, they proposed that such psyhotic states should be designated as "Obsessive compulsive disorder with Psychotic features".