Abstracts
Abstract
Background The co-occurrence of schizophrenia and obsessive-compulsive disorder has attracted increasing clinical and research attention, yet it is not recognised as a distinct diagnostic entity in current psychiatric classification systems. This overlap is associated with greater symptom severity, increased suicide risk, and poorer treatment outcomes. Despite its clinical relevance, reports from South Asia remain scarce. This case contributes regional data and supports the conceptualisation of a schizo-obsessive subtype, challenging existing nosological boundaries.
Case Presentation We report the case of a 29-year-old man with progressive social withdrawal, persecutory beliefs, and second-person auditory hallucinations. Symptoms emerged insidiously following a relational stressor and included religious-themed command hallucinations leading to a suicide attempt. Concurrently, he experienced intrusive, ego-dystonic religious images during prayer, accompanied by compulsive hand-washing and mental neutralising rituals related to blasphemous fears. There was no history of prior psychiatric treatment, substance use, or neurological illness. Mental state examination and structured assessments supported a diagnosis of schizophrenia with co-morbid moderate obsessive-compulsive symptoms. Treatment with olanzapine, followed by escitalopram, resulted in symptomatic improvement. Exposure and response prevention therapy showed sustained benefit in follow-up.
Conclusions This case highlights the clinical importance of recognising co-occurring schizophrenia and obsessive-compulsive symptoms, regardless of medication or neurological issues. Prominent religious themes suggest considering cultural and religious contexts, especially in highly religious societies. As a rare detailed report from Pakistan, it provides valuable regional data and indicates schizo-obsessive presentations may be under-recognised in South Asia. Recognising this profile can improve diagnosis, foster culturally sensitive treatments, and encourage further research.
Keywords:
- schizo-obsessive disorder,
- schizophrenia,
- obsessive-compulsive disorder,
- South Asia,
- case report
Résumé
Contexte La cooccurrence de la schizophrénie et du trouble obsessionnel-compulsif suscite un intérêt croissant chez les cliniciens et les chercheurs, mais elle n’est pas reconnue comme une entité diagnostique distincte dans les systèmes actuels de classification psychiatrique. Ce chevauchement est associé à une plus grande gravité des symptômes, à un risque accru de suicide et à de moins bons résultats thérapeutiques. Malgré son importance clinique, les rapports provenant d’Asie du Sud restent rares. Ce cas apporte des données régionales et soutient la conceptualisation d’un sous-type schizo-obsessionnel, remettant en question les frontières nosologiques existantes.
Présentation du cas Nous rapportons le cas d’un homme de 29 ans présentant un retrait social progressif, des croyances persécutrices et des hallucinations auditives à la deuxième personne. Les symptômes sont apparus insidieusement à la suite d’un facteur de stress relationnel et comprenaient des hallucinations de commandement à caractère religieux conduisant à une tentative de suicide. Parallèlement, il a fait l’expérience d’images religieuses intrusives et égodystoniques pendant la prière, accompagnée d’un lavage compulsif des mains et de rituels mentaux de neutralisation liés à des craintes blasphématoires. Il n’y avait pas d’antécédents de traitement psychiatrique, de consommation de substances ou de maladie neurologique. L’examen de l’état mental et les évaluations structurées ont confirmé un diagnostic de schizophrénie avec des symptômes obsessionnels-compulsifs modérés en comorbidité. Un traitement à l’olanzapine, suivi d’un traitement à l’escitalopram, a entraîné une amélioration des symptômes. La thérapie d’exposition et de prévention de la réponse a montré un bénéfice durable lors du suivi.
Conclusion Ce cas souligne l’importance clinique de reconnaître la cooccurrence de la schizophrénie et des symptômes obsessionnels-compulsifs, indépendamment du traitement médicamenteux ou des troubles neurologiques. Les thèmes religieux prédominants suggèrent de prendre en compte le contexte culturel et religieux, en particulier dans les sociétés très religieuses. En tant que rapport détaillé rare provenant du Pakistan, il fournit des données régionales précieuses et indique que les manifestations schizo-obsessionnelles pourraient être sous-diagnostiquées en Asie du Sud. La reconnaissance de ce profil peut améliorer le diagnostic, favoriser des traitements adaptés à la culture et encourager la poursuite des recherches.
Mots-clés :
- trouble schizo-obsessif,
- schizophrénie,
- trouble obsessionnel-compulsif,
- Asie du Sud,
- étude de cas
Appendices
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