Obsessive-compulsive symptoms in first episode psychosis and risk states: Systematic review with meta-analysis.

BACKGROUND AND HYPOTHESIS: Recent studies have reported high prevalences of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients. This sparked an interest in the effect of these symptoms in the clinical characteristics and outcomes of patients. However these studies have never been formally meta-analyzed. STUDY DESIGN: Systematic review and meta-analysis of prevalence of obsessive-compulsive symptoms and obsessive-compulsive disorder in at risk and first-episode psychosis patients and comparison of clinical characteristics and outcomes in patients with and without obsessive-compulsive symptoms. STUDY RESULTS: Obsessive-compulsive disorder was present in 7.9 % (5.9 to 10.0 %) and 10.5 % (8.3 to 12.8 %) and obsessive-compulsive symptoms in 21.4 % (8.3 to 38.2 %) and 34.0 % (26.3 to 42.1 %) of at risk and first episode psychosis patients respectively. The prevalences of obsessive-compulsive symptoms had high heterogeneity due in part to different measurement methods and cut-off values. Similar ages of onset for OCS and psychosis symptoms were found (mean difference - 0.49 years, 95 % CI -1.74 to 0.77). Patients with obsessive-compulsive symptoms had statistically insignificant higher Positive and Negative Syndrome Scale (positive subscale) scores and marginally higher depression scores. There were no differences between both groups in age of onset, Positive and Negative Syndrome Scale (negative subscale) score, risk of conversion to psychosis, anxiety score, suicide rate, and functionality score. CONCLUSIONS: Obsessive-compulsive disorder and obsessive-compulsive symptoms are very prevalent in at risk and first-episode psychosis patients.

Efficacy, Effect on Mood Symptoms, and Safety of Deep Brain Stimulation in Refractory Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate efficacy, effect on mood, and safety of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) at different target sites. DATA SOURCES: Electronic records from databases MEDLINE, EMBASE, and CENTRAL up to November 2019 were searched. Search terms included OCD, depression, and DBS. STUDY SELECTION: Eight randomized controlled trials (RCTs) (n = 85) and 38 observational studies (case reports and case series) (n = 225) were included. DATA EXTRACTION: In RCTs, the differences in outcomes between sham and active stimulation for OCD and depression were evaluated and the proportion of responders was determined. In all included studies, at last follow-up, the improvement from baseline in OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS score]) and a scale of weighted depression scores (WDS) were determined. Predictors of response (age, illness duration and severity, frequency parameters, and response in depression) were evaluated. The proportions of adverse events and dropouts were calculated. RESULTS: In RCTs, mean differences between sham and active stimulation in Y-BOCS and Hamilton Depression Rating Scale (HDRS) scores were -7.8 (95% CI = -11.2 to -4.3, I² = 40%, P = .0001) and -7.3 (95% CI = -11.5 to -3.0, I² = 0%, P = .0009), respectively. No differences between limbic and non-limbic targets were identified (χ² = 0.21, I² = 0%, P = .0006). At last follow-up, improvements in Y-BOCS and WDS were -15.0 (95% CI = -18.3 to -11.7, I² = 90%, P < .001) and -13.7 (95% CI = -20.1 to -7.3, I² = 76%, P < .001), respectively. No consistent predictors of response were found. There were 0.68 adverse events (95% CI = 0.59 to 0.78, I² = 88%), 0.32 serious adverse events (95% CI = 0.12 to 0.62, I² = 96%), and 0.13 dropouts (95% CI = 0.07 to 0.16, I² = 16%) per treated patient. CONCLUSIONS: DBS can significantly decrease Y-BOCS score and depressive symptoms in refractory OCD.