Eisen J L, Rasmussen S A
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, R.I.
J Clin Psychiatry. 1993 Oct;54(10):373-9.
The purpose of this study was to systematically identify and characterize the demographic and clinical features of patients with obsessive compulsive disorder (OCD) and psychotic symptoms.
From a total of 475 patients with DSM-III-R OCD evaluated and/or treated in an outpatient OCD clinic, 67 patients (14%) were identified as having psychotic symptoms in addition to OCD. Psychotic symptoms were defined as hallucinations, delusions, and/or thought disorder. Clinical and demographic data on these probands were collected from semistructured interviews and compared with data collected on the nonpsychotic OCD probands.
We identified 27 (6%) of 475 probands with DSM-III-R OCD whose only psychotic symptom was lack of insight and high conviction about the reasonableness of the obsessions ("OCD without insight"). The remainder of the patients with psychotic symptoms and OCD met criteria for distinct DSM-III-R psychotic disorders as well as OCD: 18 probands (4%) had OCD and schizophrenia, 8 probands (2%) had OCD and delusional disorder. Fourteen patients (3%) met criteria for both OCD and schizotypal personality disorder. Compared with the OCD patients without psychosis, probands with OCD and psychotic features were more likely to be male, be single, have a deteriorative course, and have had their first professional contact at a younger age. The data suggest that these differences were largely due to those patients with OCD and schizophrenia-spectrum disorders and not those probands whose only psychotic symptom was complete conviction and lack of insight about their obsessions.
There appears to be considerable heterogeneity in the clinical features of OCD patients who also have psychotic symptoms. The implications of these findings for understanding delusional states and for diagnostic classification are discussed.
本研究旨在系统地识别和描述患有强迫症（OCD）及精神病性症状患者的人口统计学和临床特征。
在一家门诊强迫症诊所接受评估和/或治疗的475例符合DSM-III-R强迫症诊断标准的患者中，67例（14%）除患有强迫症外还被认定有精神病性症状。精神病性症状定义为幻觉、妄想和/或思维紊乱。从半结构式访谈中收集这些先证者的临床和人口统计学数据，并与非精神病性强迫症先证者收集的数据进行比较。
在475例符合DSM-III-R强迫症诊断标准的先证者中，我们识别出27例（6%），其仅有的精神病性症状是缺乏自知力以及对强迫观念的合理性坚信不疑（“无自知力的强迫症”）。其余有精神病性症状和强迫症的患者既符合DSM-III-R中特定的精神病性障碍诊断标准，也符合强迫症诊断标准：18例先证者（4%）患有强迫症和精神分裂症，8例先证者（2%）患有强迫症和妄想性障碍。14例患者（3%）符合强迫症和分裂型人格障碍的诊断标准。与无精神病性症状的强迫症患者相比，有强迫症及精神病性特征的先证者更可能为男性、单身、病程呈恶化趋势，且首次专业接触的年龄更小。数据表明，这些差异很大程度上归因于患有强迫症和精神分裂症谱系障碍的患者，而非仅有的精神病性症状是对其强迫观念坚信不疑且缺乏自知力的那些先证者。
伴有精神病性症状的强迫症患者的临床特征似乎存在相当大的异质性。讨论了这些发现对理解妄想状态和诊断分类 的意义。
