Psychosis and Obsessive-Compulsive Symptoms: A Systematic Review and Meta-Analysis of Transition Risk and a Survey of Clinicians’ Perspectives on Assessment and Treatment

Hinton, William (2026) Psychosis and Obsessive-Compulsive Symptoms: A Systematic Review and Meta-Analysis of Transition Risk and a Survey of Clinicians’ Perspectives on Assessment and Treatment. Doctoral thesis, University of East Anglia.

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Abstract

Background: The overlap of obsessive-compulsive symptoms (OCS) and psychosis has been discussed for over a century, with contemporary research indicating high rates of co-occurrence and poorer outcomes compared to either condition alone. However, there are conflicting findings about the risk of developing psychosis associated with OCS and an absence of evidence on how co-occurring symptoms are managed in practice.

Methods: A systematic review, including two meta-analyses, was conducted to estimate the risk ratio of developing psychosis associated with OCS in clinical high-risk (CHR) and population-level samples. The empirical paper employed a clinician survey (N = 136) to investigate assessment and psychological intervention for individuals with psychosis and co-occurring OCS, including assessment and intervention methods, barriers, adaptations, and confidence.

Results: The findings from the systematic review indicate that OCS do not influence transition risk in CHR cohorts but substantially increased the risk of developing psychosis at population-level that includes OCS in the general population and later stages than CHR. Clinicians completing the survey predominantly used informal assessment methods and cognitive-behavioural approaches to intervention. Barriers included engagement difficulties and insufficient training, and adaptations included family involvement and idiosyncratic approaches. Clinicians reported moderate confidence levels in assessing and delivering psychological intervention for people with psychosis and OCS. For assessment, confidence was predicted by years of experience, while for psychological intervention, confidence was also predicted by receiving supervision and monthly working frequency.

Conclusion: This portfolio highlights the importance of considering OCS at various stages of the psychosis trajectory, emphasising the potential utility of clinical staging models. The empirical project indicates a reliance on eclectic approaches to the co-occurring symptoms Psychosis and OCD and clinical issues with engagement and training. Future research should help to clarify the phenomenology of OCS at different stages of psychosis using qualitative and quantitative methods. This may help to inform the design and implementation of assessment and psychological intervention for people with psychosis and co-occurring OCS.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	11 Nov 2026 11:44
Last Modified:	11 Nov 2026 11:44
URI:	https://ueaeprints.uea.ac.uk/id/eprint/105074
DOI:

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