Obsessive-compulsive disorder presenting as Schizophrenia in 18 year male: A case report

BACKGROUND: Obsessive compulsive symptoms in schizophrenia are well recognized but less researched entity. We report case of 18 year male with excessive thoughts presenting with talking to self, withdrawn behavior, suspiciousness. CASE PRESENTATION: An 18 year male brought by mother complaining of excessive thoughts regarding game designing since 1 year. Gradually phone usage was limited to videos and having noticed by father who intervened, he was experiencing sadness of mood, withdrawn behaviour, talking to self, irritability and decreased appetite. 15 days later, episode of self-harming behavior. As days passed by, thoughts were out of control and past incidents of school fights occurred as flashes of images. Since 2 months, mentions of persons observing him and thoughts put into head by classmates (Thought Insertion) with intentions of causing harm (Persecutory Delusions). On Mental status examination, decreased psychomotor activity, speech with increased reaction time and decreased tone, volume, tempo, irritable mood, inappropriate affect with Grade 3 insight. DISCUSSION & CONCLUSION: Gross et al. found that many patients with chronic course of OCD described basic symptoms as thought insertion and difficulties in discriminating intentional modalities as part of obsessive–compulsive symptomatology. This case highlights symptom progression from one spectrum to another and need for early recognition of Schizo-obsessive disorder to prevent schizophrenia in future.