# Obsessive–compulsive and catatonic symptoms in the early stages of psychosis: Are they related?

## TL;DR

This study finds that catatonic and obsessive-compulsive symptoms are common in early psychosis and are linked in specific ways.

## Contribution

The study identifies disorganized and obsessive-compulsive symptoms as risk factors for catatonia in early psychosis.

## Key findings

- 64.3% of patients showed catatonic symptoms, and 40% had clinically significant obsessive-compulsive symptoms.
- Disorganized and obsessive-compulsive symptoms independently increase the odds of catatonia.
- Positive symptoms are negatively associated with catatonia.

## Abstract

Catatonia and obsessive–compulsive symptoms (OCS) are frequently observed in patients with psychosis, even at early stages, yet their relationship remains unclear. This study aimed to examine the prevalence and association of catatonic symptoms and OCS in early-stage psychosis.

Seventy patients aged 18–55 years with early-stage psychosis (illness duration < 5 years) were assessed within 72 h of admission. Catatonic symptoms were evaluated using the Bush Francis Catatonia Rating Scale (BFCRS), OCS with the Obsessive–Compulsive Inventory-Revised (OCI-R), and psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS). Correlations between catatonic, obsessive–compulsive, and psychotic symptom dimensions were analyzed. Logistic regression assessed associations between symptom dimensions and catatonia.

Catatonic symptoms (BFCRS ≥ 3) were present in 64.3% of patients, and 40% scored above the OCI-R cut-off for clinically significant OCS. Patients with catatonia had significantly higher total OCI-R scores and higher scores across all OCI-R subscales. Strong correlations were observed between mental neutralization and washing OCI-R subscales and BFCRS scores. Logistic regression showed that higher disorganized (OR = 1.699, 95% CI: 1.141–2.529, p = 0.009) and obsessive–compulsive symptoms (OR = 1.253, 95% CI: 1.058–1.483, p = 0.009) were independently associated with increased odds of catatonia, while positive symptoms showed a significant negative association (OR = 0.796, 95% CI: 0.644–0.983, p = 0.034).

There is a high prevalence of both catatonic and obsessive–compulsive symptoms in early-stage psychosis. Disorganized and obsessive–compulsive symptoms are independent risk factors for catatonia, while positive symptoms may be protective. These findings highlight the importance of comprehensive symptom assessment in this population.

The online version contains supplementary material available at 10.1007/s00406-025-02080-2.