When Obsessive-Compulsive Disorder Mimics Schizophrenia

Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms and is normally considered a heterogeneous disorder. Sometimes, OCD seems to be psychotic in nature, being complex in the differentiation between OCD and schizophrenia. This report describes a female adult patient who was diagnosed in her adolescence with schizophrenia due to her complains of "hearing voices "criticizing her. In response to team request for a second evaluation, she was admitted to the acute inpatient service. After a careful reassessment, the core symptom was recognized as obsession, and her diagnosis was revised to OCD; this allowed for a more direct treatment and management, with cognitive-behavior therapy and high doses of selective serotonin reuptake inhibitors, achieving a sustained clinical improvement over 2 years of follow-up. Currently, she is more functional, participates in social activities, and totally recognizes the egodystonic and intrusive thoughts. This case demonstrates the importance of eliciting psychopathology in greater detail for specific diagnosis and treatment decisions, especially in a complex clinical presentation.