Cases Between OC-Spectrum and Psychotic-Spectrum?

[PETRAN]

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Ok, i'm not using the phrase "between OCD and Schizophrenia" because "spectrums" is the new hot thing to use 😛


So, yesterday i met this girl (no, it wasn't in a clinical environment) and she told me that sometimes she feels "her thoughts projected to other people, like in telepathy". "Thought projection, oh its schizophrenia"! you would shout, well, the catch is that this girl has 100% insight ("metacognition" is the term from experimental psychology/neuroscience) of her problem. She has thought of the possibility of psychosis but she doesn't think it is, since as i (she) said, she knows her thinking is irrational to the point that it gets disturbing and frustrating for her. She told me that this thought sometimes gets "repeated" , getting "stuck" in her mind making her very stressful. She doesn't believe in telepathy, precognition, or whatever other parapsychological mumbo jumbo,. She also doesn't hear voices, doesn't have hallucinations of any kind, and her thought process sounds very rational and down to earth.


I have seen this at other times as well. I remember in the mental health unit a guy having to perform various irrelevant random rituals or else a future event would turn out to be negative and people-or-himself- would get killed. Or the girl who by not praying in a ritualistc manner would evoke the wrath of god. All these people didn't explicitly "believe" in their ideas but "felt" them in an implicit way (difference between cortical and sub-cortical structures"?)


All these make me wonder whether psychosis and OC-type tendencies are more related than previously thought. Another OC-spectrum disorder- "Body Dysmorphic Disorder"- has a 50% incidence of psychotic features. Considering that both "spectrums" (somehow) possibly involve problems in the fronto-striatal loops, could it be that both spectrums share something in common?


What do you think of these "zebra" cases? (well, "zebra cases" are more common in mental health than the normal ones 😛 ) What about therapy? I can see an extensive and rigorous CBT approach to be helpful, but what about pharmacotherapy? Would you prescribe an SSRI or an anti-psychotic? Both?

 

[Ibid]

Thinly disguised request for dating advice here.

• Yes, she wants you.
• Next time go to a film and talk about that. This line of conversation has a limited shelf life and could seriously jeopardise your chances of consummating the relationship.
• If you get cast in the role of unpaid therapist she may implement the notouch rule and you don’t want that do you?

Good Luck.

 

[PETRAN]

Thinly disguised request for dating advice here.

• Yes, she wants you.
• Next time go to a film and talk about that. This line of conversation has a limited shelf life and could seriously jeopardise your chances of consummating the relationship.
• If you get cast in the role of unpaid therapist she may implement the notouch rule and you don't want that do you?

Good Luck.

i lol'ed


I was ready to mention that it wasn't in clinical grounds but not in personal either 😛

And it was more used as an example of those cases and destined for a serious conversation damn ibid


Besides, i could maliciously take opportunity of her "ability" and say something like "oh baby i can feel your love, its definitely there, do you wanna feel mine?" or a winning phrase like that

 

[Ibid]

i say something like "oh baby i can feel your love, its definitely there, do you wanna feel mine?" or a winning phrase like that

Now this is the sort of gold dust that I have been looking for all my life!

Any more like this pm me!!!!! You got outcome data for this phrase????

 

[393656]

First off 50 percent of BDD do not have psychosis! SHow me that citation!

Second, spectrum is not a "hot thing to say" it is reality stemming from a better understanding of these illnesses and quite frankly its common sense that there is a whole variety of severities in every feasible illness.

Before you lose insight and have true "psychosis" lacking insight, there is a progression from symptoms such as you describe such as "odd thoughts" ruminating thoughts etc. That is pretty common prodromal schizophrenia.

Considering antipsychotics are somewhat helpful in severe OCD it makes sense severe obsessions are related to psychosis in atleast a couple common pathways. "fixed" beliefs and thoughts are pretty common to both OCD and psychosis/delusions and I just do not think we are advanced enough to identify the subtle differences making them present as OCD v. psychosis.

However telepathy with insight is definetly not OCD-sounds like prodrome schizophrenia on the verge of being psychotic

 

[PETRAN]

First off 50 percent of BDD do not have psychosis! SHow me that citation!

Second, spectrum is not a "hot thing to say" it is reality stemming from a better understanding of these illnesses and quite frankly its common sense that there is a whole variety of severities in every feasible illness.

Before you lose insight and have true "psychosis" lacking insight, there is a progression from symptoms such as you describe such as "odd thoughts" ruminating thoughts etc. That is pretty common prodromal schizophrenia.

Considering antipsychotics are somewhat helpful in severe OCD it makes sense severe obsessions are related to psychosis in atleast a couple common pathways. "fixed" beliefs and thoughts are pretty common to both OCD and psychosis/delusions and I just do not think we are advanced enough to identify the subtle differences making them present as OCD v. psychosis.

However telepathy with insight is definetly not OCD-sounds like prodrome schizophrenia on the verge of being psychotic

I know that spectrum is a reality, i said it as a joke. I'm a spectrum believer as well.

Yes around half of the BDD cases have the "delusional type" (what i meant with "psychotic features", in DSM it is listed as "delusional disorder-somatic type") They have severe symptoms related to their imagined deformities and they completely lack insight that they are deluded.


"Convention, and DSM-IV, have dictated that it is important to distinguish between delusional and non-delusional forms of BDD. Indeed, cases in which the dysmorphic concern reaches delusional intensity are required by DSM-IV to be classified with the delusional (paranoid) disorders, and Munro (1980) suggests that such patients have a form of monosymptomatic hypochondriacal delusion which warrants treatment with the antipsychotic, pimozide. However, such a dichotomy on the basis of intensity of belief has been challenged, and after all, it has now been acknowledged in DSM-IV that the compulsions associated with OCD can reach delusional intensity, without the necessity for a change of diagnosis"


"Phillips et al (1994) investigated 100 cases of BDD specifically to address the issue of whether there is a delusional subtype of the disorder. These authors found that 52 BDD cases with the 'delusional' form of disorder did not differ from their 'non-delusional' counterparts in terms of demographic parameters, phenomenology (apart from intensity of belief), associated features or comorbidity."

http://apt.rcpsych.org/cgi/reprint/5/3/171.pdf




I agree with you on the thing that they share something in common. Don't be so sure though that what i saw was "prodromal schizophrenia". The girl has the symptoms for a long time now but no psychotic breakdown in-sight (no pan intended). The girl gets stressed every-time she feels she projects her thoughts to other people and she performs various "mental rituals" such as counting the number of times she will predict the other person's movements. This-from what i understand- leads to a vicious circle in which more "thought-projection" leads to more "prediciton rituals" and so on and so on.



I found this very good article with what exactly i had in mind


http://bjp.rcpsych.org/cgi/content/full/176/3/281

Take a look at the cases, this is what i was talking about. A lost of these (if not all) could be mistaken for schizophrenia or delusional disorder. It is interesting that-according to the article- these patients don't respond to antipsychotics but to the SS and SNRIs.

 

[whopper]

There are some studies showing that at a low dose (and only at a low dose) of atypical antipsychotics can augment OCD treatment with SSRIs.
http://focus.psychiatryonline.org/cgi/content/full/5/3/354

Some extreme cases of OCD could look like psychosis. You got to try to understand the phenomenon going on in the person as best you can. Do not merely look at the signs, but also listen to the person's complaints.

Howard Hughes, for example, did look like he had schizophrenia, but the consensus of people who studied his life believe he had OCD. OCD left untreated, in the more extreme forms could look like schizophrenia.

 

[393656]

Having a "delusional" componenent to BDD is far from them having "comorbid psychosis" Could not be two things further from being related. Delusional quality meaning what they believe about their body is not real-ie I am too skinny.

That has nothing to do with true lack of insight psychosis.

 

[PETRAN]

Having a "delusional" componenent to BDD is far from them having "comorbid psychosis" Could not be two things further from being related. Delusional quality meaning what they believe about their body is not real-ie I am too skinny.

That has nothing to do with true lack of insight psychosis.

I never said about co-morbid psychosis (e.g. with voices, thought disorder or negative symtpoms) this is your conclusion. I said that 50% has "psychotic features". Have you seen a delusional BDD? This is why it is called "delusional", people lack insight of their condition. I've met a delusional type BDD female patient and she thought that she had white skin and she couldn't understand that it wasn't white no matter how hard i tried to convince her otherwise. She also thought that people were starring at her "whiteness" and loughing behind her back. She got worst to the point of repeating various white-related colors and communicating like she had thought disorder. Psychiatrist thought that she had a psychotic breakdown and tried various anti-psychotics, some of which made her feel worst. As far as i can remember she got relief with aripiprazole plus a very high dose of an SSRI and a benzo. Another guy thought that his bones were protruding and reached to the point of thinking that not performing rituals would lead to a literal bone deformation. If you see a "delusional type" BDD in the severe acute phase it looks very much like some kind of schizophrenic breakdown with extreme delusional ideas and complete lack of insight. It could very much be a hypochondrial-type psychosis without the voices. The chance of commiting suicide is also one of the highest.