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Abstract
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Aims
The increasing overlap between schizophrenia and obsessive-compulsive symptoms (OCS) presents a major diagnostic challenge in mental health. This report aims to explore the difficulties in accurately diagnosing these conditions.
Methods
This case report is based on a retrospective review of the patient's anonymized medical and psychiatric records, including evaluations, progress notes, and treatment summaries.
Results
At age 9, the patient developed compulsions, and by 12, his condition worsened with severe OCS, mutism, neglect of hygiene, refusal to eat or drink, and prolonged bed confinement. Diagnosed with OCD at 13, he was hospitalized five times with fluctuating symptoms and limited response to given medication and CBT, despite normal neurological and somatic findings. The initial signs of schizophrenia during admission included impaired social functioning, mutism, hypobulia, and odd behavior. The patient displayed egosyntonic delusional thinking, unable to correct his beliefs, and distress when rituals were disrupted. OCS occurred solely in a delusional context, with rituals losing their purpose. Previous hospitalizations noted disorganized thoughts, a sense of lost control, and feelings of being controlled by external forces. Delusional rituals, passivity phenomena, negative symptoms, and psychomotor disturbances led to a diagnosis of schizophrenia with comorbid OCS.
Conclusions
The overlap between OCS and schizophrenia complicates diagnosis, requiring careful evaluation of negative symptoms, egosyntonic vs. egodystonic features, and distress caused by compulsions. Delayed diagnosis and treatment can lead to a treatment-resistant condition and worse prognosis. Further research is needed on diagnosing and treating schizophrenia with OCS.
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