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Complications in Diagnosing Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental condition well known for its ability to produce a combination of mental obsessions and compulsive behaviors. Sometimes, mental health professionals have a fairly easy time diagnosing the condition’s presence in their patients. However, certain factors can complicate an OCD diagnosis and create a much more complex picture for doctors. In some cases, affected individuals develop a form of obsessive-compulsive disorder that closely mimics the symptoms of the psychotic disorder schizophrenia. In other cases, people with existing cases of schizophrenia develop medication side effects that strongly resemble the symptoms of OCD.

OCD Basics

Obsessive-compulsive disorder forms the linchpin of a category of mental illnesses called obsessive-compulsive and related disorders. In its classic form, the disorder features recurring mental images or thoughts (obsessions) that preoccupy and destabilize the minds of affected individuals, as well as recurring, involuntary behaviors (compulsions) that function as responses to obsessive states of mind. Unlike the preoccupations and behaviors found in the average, mentally healthy person, the preoccupations and behaviors in an individual with OCD significantly restrict that person’s sense of well-being or ability to interact fully or appropriately in different kinds of social settings.

OCD With Poor Insight

Most people affected by OCD know on some level that their obsessions and compulsions are dysfunctional and irrational. Generally speaking, this self-awareness gives doctors a ready avenue for treating the disorder as part of a cooperative effort with their patients. However, some individuals develop a form of obsessive-compulsive disorder called OCD with poor insight. People with this form of the disorder lack self-awareness regarding the nature of their obsessions and compulsions. In turn, this lack of perspective limits their ability to participate in their treatment or cooperate with their doctors’ efforts.

Crucially, the absence of personal perspective in a person with OCD can lead to the onset of obsessions and compulsions that are intense and entrenched enough to strongly resemble the symptoms of psychosis (i.e., delusional thinking and hallucinations) that commonly appear in individuals affected by schizophrenia or several other related conditions. In fact, doctors diagnosing people who appear psychotic must work diligently to avoid mistakenly diagnosing OCD with poor insight as a schizophrenia-related condition. The situation is even further complicated by the fact that any given individual can have coexisting cases of schizophrenia and OCD.

OCD-Like Medication Side Effects

The primary medications used to treat the psychotic symptoms of schizophrenia belong to a class of drugs called antipsychotics. One particular group of antipsychotics, called atypical antipsychotics or serotonin-dopamine antagonists, can produce side effects that strongly resemble the principle symptoms of obsessive-compulsive disorder, according to a summary report published in 2013 in Psychiatric Times. A separate study, published in 2012 in the Journal of Clinical Psychiatry, examined the risks for OCD-like symptoms associated with the use of specific antipsychotic medications. The authors of this study concluded that the clearest risks are linked to the use of a medication called clozapine (Clozaril, FazaClo). Out of all clozapine users, the highest risks appear in people who take the medication for at least half a year.

Considerations

Doctors can sometimes effectively treat OCD with poor insight with the help of antidepressant medications called SSRIs; whenever possible, they avoid adding any type of antipsychotic medication to the treatment regime. When diagnosing cases of OCD in people affected by schizophrenia or a schizophrenia-related disorder, doctors must always safeguard against the possibility of mistakenly identifying the side effects of antipsychotic use as the symptoms of obsessive-compulsive disorder. If OCD-like symptoms appear in a person taking an antipsychotic, an adjustment in the dose of the antipsychotic in question may eliminate those symptoms. However, doctors may eventually need to replace the medication with an alternative that doesn’t produce OCD-like side effects. In cases where affected individuals can’t change or adjust their medications, doctors typically manage any side effects to the best of their ability.

In order to tell the difference between obsessive-compulsive disorder, OCD with poor insight, schizophrenia, and OCD-like medication side effects, doctors rely heavily on thorough medical histories of their patients, as well as on monitoring and periodic review of their patients’ symptoms and patterns of medication usage. Generally speaking, people diagnosed with both OCD and schizophrenia benefit from combined treatment with antipsychotic medications, SSRIs, and a form of psychotherapy called cognitive behavioral therapy (CBT).

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