Obsessive-compulsive disorder with psychotic features in adolescence

Abstract

Relationship between obsessive-compulsive disorder (OCD) and psychotic pathology is a controversial one. Case reports indicate that OCD with psychotic features is generally more severe and antidepressant-refractory than neurotic OCD. Behaviour therapy is shown to be ineffective in OCD patients with psychotic features. One of the subtypes includes reactive paranoid forms, with fluctuating clinical course, in obsessive patients with delusional thoughts that improve with neuroleptic augmentation of the serotonin reuptake inhibitor (SRI) treatment for OCD. We present the case of a 17-year-old woman with family history of OCD, starting with panic symptoms after cannabis use, but suddenly developing OCD with avoidant behavior and delusional ideas of self-reference and persecution. Response to behavior therapy and SRI and neuroleptics is analyzed.