Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; Department of Applied Science (Occupational Therapy), University of Western Sydney, Australia.
Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Schizophr Res. 2019 Jul;209:58-63. doi: 10.1016/j.schres.2019.05.024. Epub 2019 May 24.
High comorbidity of obsessive-compulsive disorder (OCD) has been reported in patients with schizophrenia. The sequence of OCD and schizophrenia onset might clarify the underlying pathophysiological relationships between these two disorders, but available evidence is limited. In this study, we used a population-based cohort to investigate the risk of schizophrenia in people with newly diagnosed OCD. Patients who were first diagnosed with OCD from 2000 to 2013 were selected from the Longitudinal Health Insurance Research Database. The non-OCD group was randomly sampled, and matched with the OCD group by gender, age, urbanization level, and income. Cox regression analyses and competing risk model were used to estimate the risk of schizophrenia, adjusting for potential confounding factors. In total, 2009 patients with OCD and 8036 controls were identified. The crude incidences of schizophrenia in the OCD and non-OCD groups were 876.2 per 100,000 person-years and 28.7 per 100,000 person-years, respectively. After adjustment, a substantially higher risk of schizophrenia was observed in the OCD group (hazard ratio = 30.29, 95% confidence interval = 17.91-51.21). Male gender, age of OCD onset before 20 years, and antipsychotic prescription were associated with schizophrenia. Patients with comorbidity of autistic disorder have higher risk of schizophrenia (hazard ratio = 4.63, 95% confidence interval = 1.58-13.56). In conclusion, OCD diagnosis, male gender, age of OCD onset before 20 years, comorbidity of autistic disorder, and antipsychotic use were associated with higher risk of schizophrenia. It is essential for psychiatrists to note that OCD may be the initial presentation of schizophrenia.
强迫症（OCD）与精神分裂症的共病率较高。OCD 和精神分裂症发病顺序可能阐明这两种疾病之间的潜在病理生理关系，但现有证据有限。在这项研究中，我们使用基于人群的队列研究来调查新诊断为 OCD 的患者患精神分裂症的风险。我们从纵向健康保险研究数据库中选择了 2000 年至 2013 年间首次被诊断为 OCD 的患者。非 OCD 组是通过随机抽样选择的，并通过性别、年龄、城市化水平和收入与 OCD 组相匹配。使用 Cox 回归分析和竞争风险模型，调整潜在混杂因素后，估计精神分裂症的风险。总共确定了 2009 例 OCD 患者和 8036 例对照者。OCD 和非 OCD 组的精神分裂症粗发病率分别为 876.2/10 万人年和 28.7/10 万人年。调整后，OCD 组精神分裂症的风险明显更高（风险比=30.29，95%置信区间=17.91-51.21）。男性、OCD 发病年龄小于 20 岁、抗精神病药物处方与精神分裂症有关。伴有自闭症共病的患者患精神分裂症的风险更高（风险比=4.63，95%置信区间=1.58-13.56）。总之，OCD 诊断、男性、20 岁前 OCD 发病年龄、自闭症共病和抗精神病药物使用与更高的精神分裂症风险相关。精神科医生必须注意到，OCD 可能是精神分裂症的首发表现。
