Obsessive-compulsive symptoms in psychotic disorders: longitudinal associations of symptom clusters on between- and within-subject levels

F. Schirmbeck*, Max Konijn, Vera Hoetjes, Mathias Zink, Lieuwe de Haan, B. Z. Alizadeh, A. A. Bartels-Velthuis, R. Bruggeman, N. J. van Beveren, W. Cahn, R. S. Kahn, N. E. van Haren, L. de Haan, C. J. Meijer, C. J. P. Simons, J. van Os, P. Delespaul, I. Myin-Germeys, R. van Winkel, Genetic Risk and Outcome of Psychosis (GROUP) Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Obsessive-compulsive symptoms (OCS) are frequently reported in patients with schizophrenia and have been associated with subjective distress and higher impairment. Recent studies suggest fluctuation in co-occurring OCS and associations with the course of psychotic symptoms. Current evidence is limited by few studies with long assessments intervals and a sole focus on between-subject comparisons. The aim of this study was to specifically investigate co-variation of symptom domains over time within individuals. Patients with a psychotic disorder (n=56) and un-affected siblings (n=49) completed monthly assessments of clinical and subclinical symptoms over 6months. Mixed-model multilevel analyses examined the variability and relationship between OCS and positive, negative, and depressive symptoms on the between- and within-subject level. Symptom domains were associated across subjects and assessment times, in patients and siblings, with the strongest association between OCS and (subclinical) positive symptoms. Within-subjects, substantial variability and co-variation of all symptom domains was found. Particularly, between-subject differences in positive symptoms and within-subject change in depressive symptoms predicted subsequent OCS in patients 1months later. This is the first prospective study disaggregating between and within-subject associations between co-occurring OCS and symptom cluster of psychosis. Differences on these two levels suggest different underlying mechanisms. The association between depressive symptoms and subsequent increase/decrease of OCS within patients may have important treatment implications.

Original languageEnglish
Pages (from-to)245-255
Number of pages11
JournalEuropean Archives of Psychiatry and Clinical Neuroscience
Issue number2
Publication statusPublished - Mar 2019


  • Psychosis
  • Obsessive-compulsive
  • Comorbidity
  • Longitudinal
  • Within-subject


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