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Bu sayfa, 26. Dünya Psikiyatri Kongresi'nde sunulan çalışmanın yapay zekâ desteğiyle hazırlanmış Türkçe özetidir. Çalışmanın sahibi sunan yazarlardır; atıf için orijinal kaynağa başvurun.

EV0928

From obsession to psychosis: progression from obsessive-compulsive disorder to schizophrenia - a narrative review

FROM OBSESSION TO PSYCHOSIS: THE PROGRESSION FROM OBSESSIVE-COMPULSIVE DISORDER TO SCHIZOPHRENIA — A NARRATIVE REVIEW

Obsessive-compulsive disorder and schizophrenia share a clinical and neurobiological continuum, and obsessive-compulsive symptoms may represent a prodrome of psychosis in a subgroup of patients.

This review aims to examine progression from obsessive-compulsive disorder (OCD) to schizophrenia, prioritizing epidemiological evidence and evidence of temporal sequencing. A narrative review was conducted by searching PubMed, PsycINFO, and Google Scholar for cohort studies, meta-analyses, reviews, case-control studies, and genetic and neuroimaging studies published between 1994 and 2025. Background data indicated a schizophrenia prevalence of approximately 0.55%, an OCD prevalence of 2-3%, and a prevalence of comorbid OCD in schizophrenia of 12-23%. Among 35,255 patients with OCD followed for eleven years, cumulative progression to schizophrenia was 6-7.8%; meta-regression indicated that the prevalence of obsessive-compulsive symptoms (OCS) in schizophrenia was 30.3%, compared with 1.1-1.8% in the general population. Risk predictors included male sex, autism spectrum disorder, bipolar disorder, cluster A personality disorder, and a family history of schizophrenia; longitudinal studies spanning 1-34 years suggest that childhood OCD may precede adult psychosis and that OCS may represent the prodromal phase in a subgroup. Shared genetic, neurobiological, and environmental etiological factors, common genetic loci/pathways in glutamatergic and dopaminergic systems, and both overlapping and distinct neuroimaging abnormalities have been reported. Clinically, patients with schizophrenia and co-occurring OCS have an earlier illness onset, more pronounced cognitive impairment, and more severe overall psychopathology; the review emphasizes that SSRIs, which are first-line treatments for OCD, may exacerbate psychotic symptoms during the prodromal phase of schizophrenia, highlighting the risk of misdiagnosis and inappropriate pharmacological treatment. The authors recommend early recognition of OCS in at-risk groups, the development of redefined nosological frameworks and tailored interventions for schizo-obsessive presentations, and prioritization of prospective longitudinal designs and genetic/neuroimaging markers.

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