Treatment of co-occurring obsessive-compulsive and psychotic symptoms: A systematic review

Up to 30% of individuals with psychosis also experience significant obsessive-compulsive symptoms (OCS). This common, yet understudied, co-occurrence is associated with a more severe clinical presentation and course than psychosis alone, making identifying effective treatments for this comorbidity profile critical. This systematic review synthesized the literature published between 1976 and 2020 on psychopharmacological, psychosocial, and other treatment approaches for co-occurring OCS and psychosis. Our review identified 42 studies examining psychopharmacological (n = 32), psychosocial (n = 7), and neuromodulation (n = 3) treatments. Results suggested that there is early support for the effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors, and cognitive behavioral therapies as augmentative agents to traditional antipsychotic medications to reduce OCS within the context of psychosis. Considerable limitations across identified studies preclude reliable conclusions about the effectiveness of treatment for co-occurring OCS and psychosis. Gaps in the identified literature point to important areas for future research.