불안장애의 경계：강박장애와 정신분열병
Boundary of Anxiety Disorders：Obsessive-Compulsive Disorder and Schizophrenia
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Although obsessive-compulsive disorder (OCD) is recognized as a major psychiatric illness, few studies have investigated obsessive-compulsive symptoms in patients with schizophrenia. Recent increases in dual diagnosis due to changes to the DSMIV diagnostic criteria, findings of obsessive-compulsive symptoms (OCS) after administration of atypical antipsychotics, increased reports of co-occurrence of schizophrenia and OCD have increased the interest in OCS in schizophrenia. The incidence of OCS in patients with schizophrenia is reported to be 3-59%；however, the rate of progression to schizophrenia from OCD is not higher than in the general population. Level of insight, which differentiates obsessions from delusions, can be confounded by the specifier ‘with poor insight’ in OCD. OCD with schizotypal personality disorder or poor insight differs from pure OCD in that it responds poorly to treatment, has a poor prognosis, leads to deficits in cognitive functioning similar to those observed in schizophrenia, and responds well to low-dose antipsychotics. In the past, it was believed that OCS could prevent or delay the deteriorative course of schizophrenia. However, recent studies have shown that co-occurrence of OCD and schizophrenia increases the severity of symptoms, delays the treatment response, and reduces socio-occupational functions. Schizophrenia and OCD share the same pathophysiology in that both diseases have defects in the fronto-basal functional circuitry of the brain. The use of serotonin and dopamine has been addressed in schizophrenia due to the use of atypical antipsychotics in patients with schizophrenia. The finding of drug-induced OCS suggested that the two diseases share a similar pathogenesis involving neurotransmitters. Further studies are needed to make an exact diagnosis between the two diseases and to determine the common pathophysiology between OCD and schizophrenia. (J Korean Neuropsychiatr Assoc 2008;47(6):525-532)
Abstract
Although obsessive-compulsive disorder (OCD) is recognized as a major psychiatric illness, few studies have investigated obsessive-compulsive symptoms in patients with schizophrenia. Recent increases in dual diagnosis due to changes to the DSMIV diagnostic criteria, findings of obsessive-compulsive symptoms (OCS) after administration of atypical antipsychotics, increased reports of co-occurrence of schizophrenia and OCD have increased the interest in OCS in schizophrenia. The incidence of OCS in patients with schizophrenia is reported to be 3-59%；however, the rate of progression to schizophrenia from OCD is not higher than in the general population. Level of insight, which differentiates obsessions from delusions, can be confounded by the specifier ‘with poor insight’ in OCD. OCD with schizotypal personality disorder or poor insight differs from pure OCD in that it responds poorly to treatment, has a poor prognosis, leads to deficits in cognitive functioning similar to those observed in schizophrenia, and responds well to low-dose antipsychotics. In the past, it was believed that OCS could prevent or delay the deteriorative course of schizophrenia. However, recent studies have shown that co-occurrence of OCD and schizophrenia increases the severity of symptoms, delays the treatment response, and reduces socio-occupational functions. Schizophrenia and OCD share the same pathophysiology in that both diseases have defects in the fronto-basal functional circuitry of the brain. The use of serotonin and dopamine has been addressed in schizophrenia due to the use of atypical antipsychotics in patients with schizophrenia. The finding of drug-induced OCS suggested that the two diseases share a similar pathogenesis involving neurotransmitters. Further studies are needed to make an exact diagnosis between the two diseases and to determine the common pathophysiology between OCD and schizophrenia. (J Korean Neuropsychiatr Assoc 2008;47(6):525-532)
참고문헌 (58)
- Berrios GE, "Obsessive-compulsive disorder: its conceptual history in France during the 19th century", Compr Psychiatry, 30, pp.283~295 (1989)
- Jahrrheis W, "Obsessions during schizophrenia", Arch Psych Nervenkr, 77, pp.740~788 (1926)
- Rosen I, "The clinical significance of obsessions in schizophrenia", J Ment Sci, 103, pp.773~785 (1957)
- Fenton WS, "The prognostic significance of obsessive- compulsive symptoms in schizophrenia", Am J Psychiatry, 143, pp.437~441 (1986)
- Berman I, "Obsessive and compulsive symptoms in chronic schizophrenia", Compr Psychiatry, 36, pp.6~10 (1995)
- Eisen JL, "Obsessive-compulsive disorder in patients with schizophrenia or schizoaffective disorder", Am J Psychiatry, 154, pp.271~273 (1997)
- Fabisch K, "Obsessive-compulsive symptoms in schizophrenia", Schizophr Res, 24, pp.17~ (1997)
- Porto L, "A profile of obsessive compulsive symptoms in schizophrenia", Schizophr Res, 24, pp.20~ (1997)
- Kringlen E, "Obsessional neurotics: a long-term follow up", Br J Psychiatry, 111, pp.709~722 (1965)
- Lo W, "A follow-up study of obsessional neurotics in Hong Kong Chineses", Br J Psychiatry, 113, pp.823~832 (1967)
- Pollit JD, "Natural history of obsessional states", BMJ, 1, pp.194~198 (1957)
- Rosenberg CM, "Complications of obsessional neurosis", Br J Psychiatry, 114, pp.477~478 (1968)
- Welner A, "Obsessive compulsive neurosis: record, follow-up and family studies", Compr Psychiatry, 17, pp.527~539 (1976)
- Eisen JL, "Obsessive compulsive disorder with psychotic features", J Clin Psychiatry, 54, pp.373~379 (1993)
- Thomsen PH, "Obsessive-compulsive disorder: admission patterns and diagnostic stability. A case-register study", Acta Psychiatr Scand, 90, pp.19~24 (1994)
- Karno M, "The epidemiology of obsessive-compulsive disorder in five US communities", Arch Gen Psychiatry, 45, pp.1094~1099 (1988)
- Bland RC, "Schizophrenia: lifetime co-morbidity in a community sample", Acta Psychiatr Scand, 75, pp.383~391 (1987)
- Goodwin DW, "Follow-up studies in obsessional neurosis", Arch Gen Psychiatry, 46, pp.1006~1011 (1969)
- Nestadt G, "The relationship between obsessive- compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study", Psychol Med, 31, pp.481~487 (2001)
- Siever LJ, "The pathophysiology of schizophrenia disorders: perspectives from the spectrum", Am J Psychiatry, 161, pp.398~413 (2004)
- Dinn WM, "Positive and negative schizotypy in a student sample: neurocognitive and clinical correlates", Schizophr Res, 56, pp.171~185 (2002)
- Roth RM, "The relationship between schizotypal and obsessive- compulsive features in university students", Personality and Individual differences, 29, pp.1083~1093 (2000)
- Norman RM, "Relationship of obsessivecompulsive symptomatology to anxiety, depression and schizotypy in a clinical population", Br J Clin Psychol, 35(4), pp.553~566 (1996)
- Rossi A, "Schizotypal dimensions in normals and schizophrenic patients: a comparison with other clinical samples", Schizophr Res, 54, pp.67~75 (2002)
- Jenike MA, "Concomitant obsessivecompulsive disorder and schizotypal personality disorder", Am J Psychiatry, 143, pp.530~532 (1986)
- Rasmussen SA, "Clinical characteristics and family history in DSM-III obsessive-compulsive disorder", Am J Psychiatry, 143, pp.317~322 (1986)
- Samuels J, "Personality disorders and normal personality dimensions in obsessive-compulsive disorder", Br J Psychiatry, 177, pp.457~462 (2000)
- Sobin C, "Evidence of a schizotypy subtype in OCD", J Psychiatr Res, 34, pp.15~24 (2000)
- Baer L, "Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessivecompulsive disorder", Arch Gen Psychiatry, 49, pp.862~866 (1992)
- Ravizza L, "Predictors of drug treatment response in obsessive-compulsive disorder", J Clin Psychiatry, 56, pp.368~373 (1995)
- Matsunaga H, "Gender differences in social and interpersonal features and personality disorders among Japanese patients with obsessive-compulsive disorder", Compr Psychiatry, 41, pp.266~272 (2000)
- Albert U, "Phenomenology of patients with early and adult onset obsessive-compulsive disorder", Epidemiol Psichiatr Soc, 11, pp.116~126 (2002)
- Harris CL, "Subtyping obsessive-compulsive disorder: neuropsychological correlates", Behav Neurol, 14, pp.75~87 (2003)
- Mitropoulou V, "Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity", Biol Psychiatry, 52, pp.1175~1182 (2002)
- Coccaro EF, "Clinical outcome of psychopharmacologic treatment of borderline and schizotypal personality disordered subjects", J Clin Psychiatry, 59(1), pp.30~35 (1998)
- Foa EB, "DSM-IV field trial: obsessive- compulsive disorder", Am J Psychiatry, 152, pp.90~96 (1995)
- Insel TR, "Obsessive-compulsive disorder with psychotic features: a phenomenologic analysis", Am J Psychiatry, 143, pp.1527~1533 (1986)
- Marazziti D, "Insight in obsessivecompulsive disorder: a study of an Italian sample", Eur Psychiatry, 17, pp.407~410 (2002)
- Neziroglu F, "The Overvalued Ideas Scale: development, reliability and validity in obsessive-compulsive disorder", Behav Res Ther, 37, pp.881~902 (1999)
- Eisen JL, "Insight and treatment outcome in obsessive-compulsive disorder", Compr Psychiatry, 42, pp.494~497 (2001)
- Matsunaga H, "Obsessive-compulsive disorder with poor insight", Compr Psychiatry, 43, pp.150~157 (2002)
- Catapano F, "Insight and resistance in patients with obsessive-compulsive disorder", Psychopathology, 34, pp.62~68 (2001)
- Erzegovesi S, "Clinical predictors of drug response in obsessive-compulsive disorder", J Clin Psychopharmacol, 21, pp.488~492 (2001)
- Hollander E, "Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a doubleblind, placebo-controlled study", Int J Neuropsychopharmacol, 6, pp.397~401 (2003)
- Nechmad A, "Obsessive-compulsive disorder in adolescent schizophrenia patients", Am J Psychiatry, 160, pp.1002~1004 (2003)
- Poyurovsky M, "Obsessive-compulsive disorder in patients with first-episode schizophrenia", 156, pp.1998~2000 (1999)
- Lysaker PH, "Patterns of obsessivecompulsive symptoms and social function in schizophrenia", Psychiatry Res, 125, pp.139~146 (2004)
- Tibbo P, "Obsessive-compulsive disorder in schizophrenia", J Psychiatr Res, 34, pp.139~146 (2000)
- Lykouras L, "Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases", Prog Neuropsychopharmacol Biol Psychiatry, 27, pp.333~346 (2003)
- Kapur S, "Serotonin-dopamine interaction and its relevance to schizophrenia", Am J Psychiatry, 153, pp.466~476 (1996)
- Arnt J, "Do novel antipsychotics have similar pharmacological characteristics? A review of the evidence", Neuropsychopharmacology, 18, pp.63~101 (1998)
- Stockmeier CA, "Characterization of typical and atypical antipsychotic drugs based on in vivo occupancy of serotonin2 and dopamine2 receptors", J Pharmacol Exp Ther, 266, pp.1374~1384 (1993)
- Kapur S, "Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia", Am J Psychiatry, 156, pp.286~293 (1999)
- Gefvert O, "D(2) and 5HT(2A) receptor occupancy of different doses of quetiapine in schizophrenia: a PET study", Eur Neuropsychopharmacol, 11, pp.105~110 (2001)
- Baxter LR Jr, "Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive- compulsive disorder", Arch Gen Psychiatry, 49, pp.681~689 (1992)
- Andreasen NC, "Thalamic abnormalities in schizophrenia visualized through magnetic resonance image averaging", Science, 266, pp.294~298 (1994)
- Chang HH, "Treatment issues for patients with schizophrenia who have obsessive-complusive symtoms", Psychiatric Annals, 29, pp.529~532 (1999)
- Hwang MY, "Clinical and neuropsychological profiles of obsessive-compulsive schizophrenia: a pilot study", J Neuropsychiatry Clin Neurosci, 12, pp.91~94 (2000)