SIR: We appreciate Dr. Reznik and colleagues' comments on our earlier paper on obsessive-compulsive schizophrenia. As they pointed out, a subgroup of schizophrenia with severe and persistent obsessive-compulsive symptoms may possess unique clinical features, including greater negative symptoms and worse neuropsychological functioning. Unfortunately, although the nature of OC symptoms in schizophrenia has long been debated, lack of systematic studies continues to hinder the establishment of the underlying pathogenesis and the development of treatment guidelines in this difficult group of patients.
As we suggested in our paper, one possible explanation for this confusion is that the OC schizophrenia may encompass a heterogeneous group of patients with diverse clinical and biological characteristics. Currently it is unclear whether this group is best conceptualized as a distinct schizophrenic subtype, as schizophrenia with a severe OC symptom dimension, or as a subset of schizophrenia with comorbid OCD and schizophrenia.
In order to clarify these issues, further systematic studies are warranted. However, until then all three of these models should be considered in the management of OC schizophrenia.