Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2016; 6(4): 449-455
Published online Dec 22, 2016. doi: 10.5498/wjp.v6.i4.449
Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence
Antonio Tundo, Roberta Necci
Antonio Tundo, Roberta Necci, Istituto di Psicopatologia, 00196 Rome, Italy
Author contributions: Tundo A designed the research and wrote the manuscript; Tundo A and Necci R contributed to the identification of trials, the data extraction, designed the review, interpreted the results and edited the manuscript.
Supported by “Fondazione dell’Istituto di Psicopatologia Onlus”, Rome, Italy.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: This article is not a basic research or clinical research study so has not data share. No additional data are available than the articles cited in this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Antonio Tundo, MD, Istituto di Psicopatologia, Via Girolamo da Carpi 1, 00196 Rome, Italy.
Telephone: +39-06-3610955 Fax: +39-06-36002828
Received: July 27, 2016
Peer-review started: July 29, 2016
First decision: September 2, 2016
Revised: October 5, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 22, 2016

To review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis.


In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder (OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubMed search using as search string (“obsessive compulsive disorders” or “obsessive compulsive symptoms”) and (“schizophrenia” or “schizoaffective disorder” or “psychosis”) and (“cognitive behavioural therapy”). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.


The reviewed evidence indicates that CBT is: (1) safe, i.e., does not worsen psychotic symptoms; (2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity; (3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD co-occurring with psychosis; and (4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by second-generation antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.


Our results support the use of CBT for OCD in patients with psychosis.

Keywords: Obsessive compulsive disorder, Obsessive compulsive symptoms, Schizophrenia, Schizoaffective disorder, Cognitive behavioural therapy, Second-generation antipsychotic, Clozapine

Core tip: Ten percent of patients with schizophrenia fulfill criteria for obsessive compulsive disorder (OCD) and in 1/3 of cases OCD onset is related to second-generation antipsychotic (SGA) treatment. Reviewed evidence indicates that cognitive-behavioral therapy for OCD in patients with psychosis is: (1) safe (does not worsen psychotic symptoms); (2) well accepted (discontinuation rate similar to that reported for patients with OCD without psychosis); (3) effective (symptom reduction similar to that reported for patients with OCD without psychosis); and (4) effective in patients with OCD induced by SGA as well as in patients with OCD not induced by SGA. These conclusions are preliminary.