Do Obsessive-Compulsive Symptoms increase the risk of developing psychosis? A systematic review and meta-analysis

Hinton, William, Vivolo, Marco, Hodgekins, Joanne and Jiminez, Emma (2026) Do Obsessive-Compulsive Symptoms increase the risk of developing psychosis? A systematic review and meta-analysis. Schizophrenia Bulletin Open, 7 (1).

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Abstract

Background and Hypothesis: There is a phenomenological overlap of obsessive-compulsive symptoms (OCSs) and psychosis, leading to discussion about whether OCSs increase the risk of developing psychosis. Previous reviews have focused on clinical high-risk (CHR) cohorts which may misestimate risk due to sampling biases. The current systematic review and meta-analyses aimed to determine the risk of OCSs on developing psychosis in individuals classified at CHR and at the population level. Study Design: A total of 2,081 articles were screened, with 11 studies meeting criteria for inclusion. Two separate meta-analyses were conducted for CHR cohorts and for register-based cohorts to estimate the risk ratio of OCSs on developing psychosis. Study Results: In CHR cohorts, the meta-analysis found no significant difference in the risk of developing psychosis between individuals with and without OCSs (RR = 0.99, 95% CI [0.71, 1.38], P = .95) across 8 studies which observed low heterogeneity (I2 < .000%, 95% CI [0%, 67.03%]). In register-based cohorts, OCSs were associated with a 15-fold risk increase of developing psychosis (RR = 15.01, 95% CI [8.36, 26.93], P < .001), although this estimate was derived from 3 studies with significant heterogeneity (I2 = 85.1%, 95% CI [37.14%, 99.67%]). Conclusions: The limited number of studies and high heterogeneity in the population-level cohort limit any firm conclusions. However, findings indicate that OCSs may increase the risk of developing psychosis in the register-based cohorts, but not in CHR cohorts. The discrepancy may reflect shared underlying vulnerabilities present in both OCSs and psychosis that are obscured by samples enriched for psychosis risk.

Item Type:	Article
Additional Information:	Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Uncontrolled Keywords:	ocd,clinical high risk,conversion,longitudinal,schizophrenia,transition,psychiatry and mental health ,/dk/atira/pure/subjectarea/asjc/2700/2738
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health) Faculty of Medicine and Health Sciences > Research Groups > Mental Health
Related URLs:	https://www.scopus.com/pages/publication...
Depositing User:	LivePure Connector
Date Deposited:	18 May 2026 09:46
Last Modified:	31 Jul 2026 14:24
URI:	https://ueaeprints.uea.ac.uk/id/eprint/103060
DOI:	10.1093/schizbullopen/sgag011

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