Schizo-Obsessive Disorder: A Case Of Diagnostic And Therapeutic Difficulty

INTRODUCTION: A person with schizophrenia is more prone to obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) when compared to the general population. Schizo-obsessive disorder is diagnosed when a person has schizophrenia with co-existing OCD or OCS. It is associated with depressive symptoms, no definitive diagnostic criteria and has poor response to polypharmacotherapy. CASE SUMMARY: A 23-year-old-man with no significant family history and symptoms suggestive of paranoid schizophrenia, was on intermittent treatment for 6 years. Since the past one year, he also had OCS and depressive symptoms – constantly checking himself if he passed stools, reduced appetite, disturbed sleep, suicidal thoughts. He has multiple hospital visits where they have changed the anti-psychotics and their dosage, given electro-convulsive therapy, but couldn’t be relieved of his symptoms. He was started on high dose antipsychotics of two different classes and serotonin agonists, but still did not improve. CONCLUSION: Schizo-obsessive disorder is a diagnostic difficulty to the clinician, reported to have poor prognosis. It significantly affects one’s general, social and occupational functioning. Research is required on its psychopathology, treatment protocols and its diagnostic criteria is yet to be established. Antidepressant, depression, insight, internalized stigma