Basic symptoms in obsessive-compulsive disorder

Objectives Aims of this study are: (1) to analyze psychopathological relations between basic symptoms and obsessive-compulsive and psychotic features in a group of patients with obsessive-compulsive disorder (OCD); and (2) to discuss the nosological position of the obsessive subgroup with psychotic features: in particular, if they should be placed on the most serious clinical extreme of the OCD-spectrum or in the area of schizophrenia-spectrum disorders. Methods The patient cohort was composed of 68 patients with OCD, in two subgroups (OCD with and without psychotic features). All subjects completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Scale for the Assessment of Positive Symptoms (SAPS), Bonn Scale for the Assessment of Basic Symptoms (BSABS) and the Structured Interview for DSM-IV Personality Disorders (SIDP-IV). Comparisons of sociodemographic, psychopathological, and personological features between the two subgroups were examined using Student's t, Mann-Whitney's U and chi(2) tests. In the total obsessive group, statistical relations between basic symptoms and obsessive-compulsive and psychotic features were examined using Spearman's correlation test. Results Twenty subjects (29.4%) were affected by OCD with psychotic features. They were characterized by an earlier onset of obsessive illness (p < 0.05), more frequently chronic course (p < 0.01), specific pattern of basic symptoms (manifested by cognitive disturbances of ideation and perception) (p < 0.01) and a higher prevalence of schizotypal personality disorder (p < 0.01). The SAPS "delusion" subscale was correlated with the BSABS "cognitive disorders of thought and perception" subscale (p < 0.01). Conclusions Patients affected by OCD with psychotic symptoms appear to be characterized by higher levels of cognitive basic symptoms and a higher prevalence of schizotypal personality disorder. These findings have previously been shown to be associated with a higher risk of developing schizophrenia and could be considered as peculiar psychopathological conditions belonging to the schizophrenia- spectrum disorders rather than a group of obsessive patients placed on the most serious clinical extreme of OCD-spectrum.