Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder

Deborah Ahn Robins; Nina H. Grootendorst-van; Chin Kuo Chang; David Chandran; Hitesh Shetty; Jyoti Sanyal; James H. MacCabe; Hannah Cohen; Robert Stewart; Frederike Schirmbeck; Lieuwe de Haan; Richard D. Hayes

doi:10.4088/JCP.21m14010

Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder

Deborah Ahn Robins, Nina H. Grootendorst-van, Chin Kuo Chang, David Chandran, Hitesh Shetty, Jyoti Sanyal, James H. MacCabe, Hannah Cohen, Robert Stewart, Frederike Schirmbeck, Lieuwe de Haan, Richard D. Hayes

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Abstract

Objective: Although frequently reported in psychosis, obsessive-compulsive symptoms (OCS) are often not recognized and thus undertreated. We aimed to estimate the prevalence of OCS and obsessive-compulsive disorder (OCD) in patients with schizophrenia, schizoaffective disorder, or bipolar disorder in clinical records and identify clinical associations of OCS co-occurrence. Methods: Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre case register. The study population was restricted to individuals diagnosed with schizophrenia (ICD F20.x), schizoaffective disorder (ICD F25.x), or bipolar disorder (ICD F31.x) between 2007 and 2015. OCS and OCD were ascertained from structural fields and via Natural Language Processing software applied to free-text records. Clinical characteristics were obtained from Health of the Nation Outcome Scales for the analyses on associations between clinical characteristics and OCS/OCD status using logistic regressions with confounders considered. Results: 22,551 cases of schizophrenia, schizoaffective disorder, or bipolar disorder were identified in the observation window. Among these, 5,179 (24.0%) were identified as having OCS (including an OCD diagnosis) and 2,574 (11.9%) specifically with comorbid OCD. OCS/OCD was associated with an increased likelihood of recorded aggressive behavior (OR = 1.18; 95% CI, 1.10-1.26), cognitive problems (OR = 1.21; 95% CI, 1.13-1.30), hallucinations and delusions (OR = 1.11; 95% CI, 1.04-1.20), and physical problems (OR = 1.17; 95% CI, 1.09-1.26). Conclusions: OCS and OCD are frequently recorded for patients with schizophrenia, schizoaffective disorder, and bipolar disorder and are associated with more severe psychiatric clinical characteristics. Automated information extraction tools hold potential to improve recognition and treatment of co-occurring OCS/OCD for psychosis.

Original language	English
Article number	21m14010
Journal	The Journal of Clinical Psychiatry
Volume	83
Issue number	6
Early online date	28 Sept 2022
DOIs	https://doi.org/10.4088/JCP.21m14010
Publication status	Published - Nov 2022

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Ahn Robins, D., Grootendorst-van, N. H., Chang, C. K., Chandran, D., Shetty, H., Sanyal, J., MacCabe, J. H., Cohen, H., Stewart, R., Schirmbeck, F., de Haan, L., & Hayes, R. D. (2022). Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder. The Journal of Clinical Psychiatry, 83(6), Article 21m14010. https://doi.org/10.4088/JCP.21m14010

@article{9bcb7e2969814f09b4f55266de587d10,

title = "Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder",

abstract = "Objective: Although frequently reported in psychosis, obsessive-compulsive symptoms (OCS) are often not recognized and thus undertreated. We aimed to estimate the prevalence of OCS and obsessive-compulsive disorder (OCD) in patients with schizophrenia, schizoaffective disorder, or bipolar disorder in clinical records and identify clinical associations of OCS co-occurrence. Methods: Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre case register. The study population was restricted to individuals diagnosed with schizophrenia (ICD F20.x), schizoaffective disorder (ICD F25.x), or bipolar disorder (ICD F31.x) between 2007 and 2015. OCS and OCD were ascertained from structural fields and via Natural Language Processing software applied to free-text records. Clinical characteristics were obtained from Health of the Nation Outcome Scales for the analyses on associations between clinical characteristics and OCS/OCD status using logistic regressions with confounders considered. Results: 22,551 cases of schizophrenia, schizoaffective disorder, or bipolar disorder were identified in the observation window. Among these, 5,179 (24.0%) were identified as having OCS (including an OCD diagnosis) and 2,574 (11.9%) specifically with comorbid OCD. OCS/OCD was associated with an increased likelihood of recorded aggressive behavior (OR = 1.18; 95% CI, 1.10-1.26), cognitive problems (OR = 1.21; 95% CI, 1.13-1.30), hallucinations and delusions (OR = 1.11; 95% CI, 1.04-1.20), and physical problems (OR = 1.17; 95% CI, 1.09-1.26). Conclusions: OCS and OCD are frequently recorded for patients with schizophrenia, schizoaffective disorder, and bipolar disorder and are associated with more severe psychiatric clinical characteristics. Automated information extraction tools hold potential to improve recognition and treatment of co-occurring OCS/OCD for psychosis.",

author = "{Ahn Robins}, Deborah and Grootendorst-van, {Nina H.} and Chang, {Chin Kuo} and David Chandran and Hitesh Shetty and Jyoti Sanyal and MacCabe, {James H.} and Hannah Cohen and Robert Stewart and Frederike Schirmbeck and {de Haan}, Lieuwe and Hayes, {Richard D.}",

note = "Funding Information: funding from Lundbeck, unrelated to this work. Drs with GATE{\textquoteright}s full lifecycle open source text Getting more out ofbiomedical documents Grootendorst-van Mil, Chandran, Sanyal, Cohen, analytics. PLOS Comput Biol. Schirmbeck, and de Haan and Ms Robins have no 2013;9(2):e1002854.PubMed CrossRefCunill R, Castells X, Simeon D. Relationships symptomatology and severity of psychosis in conflicts of interest to disclose.betweenobsessive-compulsive 12. Chandran D, Robbins DA, Chang CK, et al. Use schizophrenia:asystematicreviewandmeta-Funding/support:The research was supported of natural language processing to identify by the Clinical Records Interactive Search (CRIS) analysis. J Clin Psychiatry. 2009;70(1):70–82.PubMed CrossRef obsessive compulsive symptoms in patients system funded and developed by the National with schizophrenia, schizoaffective disorder or Institute for Health Research (NIHR) Mental Health Cederl{\"o}f M, Lichtenstein P, Larsson H, et al. bipolar disorder. Sci Rep. 2019;9(1):14146.PubMed CrossRef Biomedical Research Centre at South London and Obsessive-compulsive disorder, psychosis, and Goodman WK, Price LH, Rasmussen SA, et al. Maudsley NHS Foundation Trust and King{\textquoteright}s College bipolarity: a longitudinal cohort and The Yale-Brown Obsessive Compulsive Scale, I: London and a joint infrastructure grant from Guy{\textquoteright}s multigenerational family study. Schizophr Bull. development, use, and reliability. Arch Gen and St Thomas{\textquoteright} Charity and the Maudsley Charity 2015;41(5):1076–1083.PubMed CrossRef Psychiatry. 1989;46(11):1006–1011.PubMed CrossRef (grant number BRC-2011-10035). For part of the Lysaker PH, Whitney KA. Obsessive-compulsive Department for Communities and Local time spent on this project, Dr Hayes was funded symptoms in schizophrenia: prevalence, Government. English indices of deprivation by a Medical Research Council (MRC) Population correlates and treatment. Expert Rev Neurother. 2015. GOV.UK website. https://www.gov.uk/ Health Scientist Fellowship (grant number MR/ 2009;9(1):99–107.PubMed CrossRef government/statistics/english-indices-of-J01219X/1). Drs Chang, Chandran, Shetty, Sanyal, Poyurovsky M, Faragian S, Pashinian A, et al. deprivation-2015. Accessed September 2019. Cohen, Stewart, MacCabe, and Hayes and Ms Clinical characteristics of schizotypal-related de Haan L, Sterk B, van der Valk R. Presence of Robins have all received salary support from the obsessive-compulsive disorder. Psychiatry Res. obsessive compulsive symptoms in first-NIHR Mental Health Biomedical Research Centre 2008;159(1-2):254–258.PubMed CrossRef episode schizophrenia or related disorders is at South London and Maudsley NHS Foundation McGrath J, Saha S, Chant D, et al. associated with subjective well-being and Trust and King{\textquoteright}s College London. Dr Stewart Schizophrenia: a concise overview of quality of life. Early Interv Psychiatry. is additionally funded in part by (1) a Medical incidence, prevalence, and mortality. Epidemiol 2013;7(3):285–290.PubMed CrossRef Research Council (MRC) Mental Health Data Rev. 2008;30(1):67–76.PubMed CrossRef Buckley PHM. Comorbid psychiatric disorders Pathfinder Award to King{\textquoteright}s College London; (2) an Ruscio AM, Stein DJ, Chiu WT, et al. The in schizophrenia: more than just a chance NIHR Senior Investigator Award; and (3) the NIHR epidemiology of obsessive-compulsive cooccurrence. In: De Haan LSF, Zink M, eds. Applied Research Collaboration South London disorder in the National Comorbidity Survey Obsessive-Compulsive Symptoms in (NIHR ARC South London) at King{\textquoteright}s College Hospital Replication. Mol Psychiatry. 2010;15(1):53–63.PubMed CrossRef Schizophrenia. Springer; 2015. 3–10. NHS Foundation Trust. Achim AM, Maziade M, Raymond E, et al. How de Haan L, Sterk B, Wouters L, et al. The 5-year Roleofthesponsor:Thefundingagenciesprevalent are anxiety disorders in course of obsessive-compulsive symptoms and had no role in the design and conduct ofthe schizophrenia? a meta-analysis and critical obsessive-compulsive disorder in first-episode study; collection, management, analysis, and review on a significant association. Schizophr schizophrenia and related disorders. Schizophr Bull. 2011;37(4):811–821.PubMed CrossRef Bull. 2013;39(1):151–160.PubMed CrossRef interpretation ofthe data; preparation, review, or Swets M, Dekker J, van Emmerik-van 18. Faragian S, Pashinian A, Fuchs C, et al. Funding Information: The research was supported by the Clinical Records Interactive Search (CRIS) system funded and developed by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London and a joint infrastructure grant from Guy{\textquoteright}s and St Thomas{\textquoteright} Charity and the Maudsley Charity (grant number BRC-2011-10035). For part of the time spent on this project, Dr Hayes was funded by a Medical Research Council (MRC) Population Health Scientist Fellowship (grant number MR/ J01219X/1). Drs Chang, Chandran, Shetty, Sanyal, Cohen, Stewart, MacCabe, and Hayes and Ms Robins have all received salary support from the NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London. Dr Stewart is additionally funded in part by (1) a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King{\textquoteright}s College London; (2) an NIHR Senior Investigator Award; and (3) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King{\textquoteright}s College Hospital NHS Foundation Trust. Publisher Copyright: {\textcopyright} 2022 Physicians Postgraduate Press, Inc.",

year = "2022",

month = nov,

doi = "10.4088/JCP.21m14010",

language = "English",

volume = "83",

journal = "The Journal of Clinical Psychiatry",

issn = "1555-2101",

publisher = "Physicians Postgraduate Press",

number = "6",

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Ahn Robins, D, Grootendorst-van, NH, Chang, CK , Chandran, D, Shetty, H, Sanyal, J, MacCabe, JH , Cohen, H , Stewart, R, Schirmbeck, F, de Haan, L & Hayes, RD 2022, 'Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder', The Journal of Clinical Psychiatry, vol. 83, no. 6, 21m14010. https://doi.org/10.4088/JCP.21m14010

TY - JOUR

T1 - Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder

AU - Ahn Robins, Deborah

AU - Grootendorst-van, Nina H.

AU - Chang, Chin Kuo

AU - Chandran, David

AU - Shetty, Hitesh

AU - Sanyal, Jyoti

AU - MacCabe, James H.

AU - Cohen, Hannah

AU - Stewart, Robert

AU - Schirmbeck, Frederike

AU - de Haan, Lieuwe

AU - Hayes, Richard D.

N1 - Funding Information: funding from Lundbeck, unrelated to this work. Drs with GATE’s full lifecycle open source text Getting more out ofbiomedical documents Grootendorst-van Mil, Chandran, Sanyal, Cohen, analytics. PLOS Comput Biol. Schirmbeck, and de Haan and Ms Robins have no 2013;9(2):e1002854.PubMed CrossRefCunill R, Castells X, Simeon D. Relationships symptomatology and severity of psychosis in conflicts of interest to disclose.betweenobsessive-compulsive 12. Chandran D, Robbins DA, Chang CK, et al. Use schizophrenia:asystematicreviewandmeta-Funding/support:The research was supported of natural language processing to identify by the Clinical Records Interactive Search (CRIS) analysis. J Clin Psychiatry. 2009;70(1):70–82.PubMed CrossRef obsessive compulsive symptoms in patients system funded and developed by the National with schizophrenia, schizoaffective disorder or Institute for Health Research (NIHR) Mental Health Cederlöf M, Lichtenstein P, Larsson H, et al. bipolar disorder. Sci Rep. 2019;9(1):14146.PubMed CrossRef Biomedical Research Centre at South London and Obsessive-compulsive disorder, psychosis, and Goodman WK, Price LH, Rasmussen SA, et al. Maudsley NHS Foundation Trust and King’s College bipolarity: a longitudinal cohort and The Yale-Brown Obsessive Compulsive Scale, I: London and a joint infrastructure grant from Guy’s multigenerational family study. Schizophr Bull. development, use, and reliability. Arch Gen and St Thomas’ Charity and the Maudsley Charity 2015;41(5):1076–1083.PubMed CrossRef Psychiatry. 1989;46(11):1006–1011.PubMed CrossRef (grant number BRC-2011-10035). For part of the Lysaker PH, Whitney KA. Obsessive-compulsive Department for Communities and Local time spent on this project, Dr Hayes was funded symptoms in schizophrenia: prevalence, Government. English indices of deprivation by a Medical Research Council (MRC) Population correlates and treatment. Expert Rev Neurother. 2015. GOV.UK website. https://www.gov.uk/ Health Scientist Fellowship (grant number MR/ 2009;9(1):99–107.PubMed CrossRef government/statistics/english-indices-of-J01219X/1). Drs Chang, Chandran, Shetty, Sanyal, Poyurovsky M, Faragian S, Pashinian A, et al. deprivation-2015. Accessed September 2019. Cohen, Stewart, MacCabe, and Hayes and Ms Clinical characteristics of schizotypal-related de Haan L, Sterk B, van der Valk R. Presence of Robins have all received salary support from the obsessive-compulsive disorder. Psychiatry Res. obsessive compulsive symptoms in first-NIHR Mental Health Biomedical Research Centre 2008;159(1-2):254–258.PubMed CrossRef episode schizophrenia or related disorders is at South London and Maudsley NHS Foundation McGrath J, Saha S, Chant D, et al. associated with subjective well-being and Trust and King’s College London. Dr Stewart Schizophrenia: a concise overview of quality of life. Early Interv Psychiatry. is additionally funded in part by (1) a Medical incidence, prevalence, and mortality. Epidemiol 2013;7(3):285–290.PubMed CrossRef Research Council (MRC) Mental Health Data Rev. 2008;30(1):67–76.PubMed CrossRef Buckley PHM. Comorbid psychiatric disorders Pathfinder Award to King’s College London; (2) an Ruscio AM, Stein DJ, Chiu WT, et al. The in schizophrenia: more than just a chance NIHR Senior Investigator Award; and (3) the NIHR epidemiology of obsessive-compulsive cooccurrence. In: De Haan LSF, Zink M, eds. Applied Research Collaboration South London disorder in the National Comorbidity Survey Obsessive-Compulsive Symptoms in (NIHR ARC South London) at King’s College Hospital Replication. Mol Psychiatry. 2010;15(1):53–63.PubMed CrossRef Schizophrenia. Springer; 2015. 3–10. NHS Foundation Trust. Achim AM, Maziade M, Raymond E, et al. How de Haan L, Sterk B, Wouters L, et al. The 5-year Roleofthesponsor:Thefundingagenciesprevalent are anxiety disorders in course of obsessive-compulsive symptoms and had no role in the design and conduct ofthe schizophrenia? a meta-analysis and critical obsessive-compulsive disorder in first-episode study; collection, management, analysis, and review on a significant association. Schizophr schizophrenia and related disorders. Schizophr Bull. 2011;37(4):811–821.PubMed CrossRef Bull. 2013;39(1):151–160.PubMed CrossRef interpretation ofthe data; preparation, review, or Swets M, Dekker J, van Emmerik-van 18. Faragian S, Pashinian A, Fuchs C, et al. Funding Information: The research was supported by the Clinical Records Interactive Search (CRIS) system funded and developed by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity (grant number BRC-2011-10035). For part of the time spent on this project, Dr Hayes was funded by a Medical Research Council (MRC) Population Health Scientist Fellowship (grant number MR/ J01219X/1). Drs Chang, Chandran, Shetty, Sanyal, Cohen, Stewart, MacCabe, and Hayes and Ms Robins have all received salary support from the NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Dr Stewart is additionally funded in part by (1) a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King’s College London; (2) an NIHR Senior Investigator Award; and (3) the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. Publisher Copyright: © 2022 Physicians Postgraduate Press, Inc.

PY - 2022/11

Y1 - 2022/11

N2 - Objective: Although frequently reported in psychosis, obsessive-compulsive symptoms (OCS) are often not recognized and thus undertreated. We aimed to estimate the prevalence of OCS and obsessive-compulsive disorder (OCD) in patients with schizophrenia, schizoaffective disorder, or bipolar disorder in clinical records and identify clinical associations of OCS co-occurrence. Methods: Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre case register. The study population was restricted to individuals diagnosed with schizophrenia (ICD F20.x), schizoaffective disorder (ICD F25.x), or bipolar disorder (ICD F31.x) between 2007 and 2015. OCS and OCD were ascertained from structural fields and via Natural Language Processing software applied to free-text records. Clinical characteristics were obtained from Health of the Nation Outcome Scales for the analyses on associations between clinical characteristics and OCS/OCD status using logistic regressions with confounders considered. Results: 22,551 cases of schizophrenia, schizoaffective disorder, or bipolar disorder were identified in the observation window. Among these, 5,179 (24.0%) were identified as having OCS (including an OCD diagnosis) and 2,574 (11.9%) specifically with comorbid OCD. OCS/OCD was associated with an increased likelihood of recorded aggressive behavior (OR = 1.18; 95% CI, 1.10-1.26), cognitive problems (OR = 1.21; 95% CI, 1.13-1.30), hallucinations and delusions (OR = 1.11; 95% CI, 1.04-1.20), and physical problems (OR = 1.17; 95% CI, 1.09-1.26). Conclusions: OCS and OCD are frequently recorded for patients with schizophrenia, schizoaffective disorder, and bipolar disorder and are associated with more severe psychiatric clinical characteristics. Automated information extraction tools hold potential to improve recognition and treatment of co-occurring OCS/OCD for psychosis.

AB - Objective: Although frequently reported in psychosis, obsessive-compulsive symptoms (OCS) are often not recognized and thus undertreated. We aimed to estimate the prevalence of OCS and obsessive-compulsive disorder (OCD) in patients with schizophrenia, schizoaffective disorder, or bipolar disorder in clinical records and identify clinical associations of OCS co-occurrence. Methods: Data were retrieved from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre case register. The study population was restricted to individuals diagnosed with schizophrenia (ICD F20.x), schizoaffective disorder (ICD F25.x), or bipolar disorder (ICD F31.x) between 2007 and 2015. OCS and OCD were ascertained from structural fields and via Natural Language Processing software applied to free-text records. Clinical characteristics were obtained from Health of the Nation Outcome Scales for the analyses on associations between clinical characteristics and OCS/OCD status using logistic regressions with confounders considered. Results: 22,551 cases of schizophrenia, schizoaffective disorder, or bipolar disorder were identified in the observation window. Among these, 5,179 (24.0%) were identified as having OCS (including an OCD diagnosis) and 2,574 (11.9%) specifically with comorbid OCD. OCS/OCD was associated with an increased likelihood of recorded aggressive behavior (OR = 1.18; 95% CI, 1.10-1.26), cognitive problems (OR = 1.21; 95% CI, 1.13-1.30), hallucinations and delusions (OR = 1.11; 95% CI, 1.04-1.20), and physical problems (OR = 1.17; 95% CI, 1.09-1.26). Conclusions: OCS and OCD are frequently recorded for patients with schizophrenia, schizoaffective disorder, and bipolar disorder and are associated with more severe psychiatric clinical characteristics. Automated information extraction tools hold potential to improve recognition and treatment of co-occurring OCS/OCD for psychosis.

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U2 - 10.4088/JCP.21m14010

DO - 10.4088/JCP.21m14010

M3 - Article

C2 - 36170204

AN - SCOPUS:85139375939

SN - 1555-2101

VL - 83

JO - The Journal of Clinical Psychiatry

JF - The Journal of Clinical Psychiatry

IS - 6

M1 - 21m14010

ER -

Prevalence and Correlates of Obsessive-Compulsive Symptoms in Individuals With Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder

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