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The clinical meaning of obsessive-compulsive symptoms in bipolar disorder and schizophrenia

The rate of co-morbid obsessivecompulsive disorder (OCD) with both bipolar and schizophrenia spectrum disorders is high. The lifetime prevalence of bipolar disorder (BD) in OCD patients is up to 21.5% and almost 50% of OCD patients have cyclothimic traits (D’Ambriosio et al., 2010). Co-morbid OCD is diagnosed in 8–32% of patients with schizophrenia (SCZ) and in up to 35% of patients with schizotypal personality disorder (de Haan et al., 2013). On one hand, BD-OCD is associated with poorer functioning as compared to ‘pure’ BD or ‘pure’ OCD (Amerio et al., 2014). On the other hand the impact of OC symptoms (OCS) on functioning in SCZ might depend on their severity: OCS might have an improving effect while a fullblown OCD might have a worsening one (de Haan et al., 2013). In line with these findings, preliminary results of our recent study have showed a gradual transition from an improving effect (mild OCS) to a worsening one (moderate–severe OCS) on functioning in SCZ subjects. OC symptoms are mediated by fronto-striato-thalamic circuits which have a crucial role in the regulation of daily master routines and sub-routines. Since these circuits can also be involved in the pathogenesis of BD and SCZ, OCS may have different clinical meanings in these disorders: