Coexistent Obsessive-Compulsive Disorder and Schizotypal Personality Disorder: A Poor Prognostic Indicator

To the Editor.—  Four years ago we began an obsessive-compulsive disorders (OCD) clinic to systematically evaluate and treat patients with these difficult disorders. All patients are initially seen by a psychiatrist to evaluate their suitability for medications. Those who are unresponsive to medication or who have clear-cut rituals are also seen by a behavioral therapist. Over the last two years, 59 patients were referred to our clinic; of these, 54 met DSM-III criteria for OCD. Of the patients with OCD, 30 were male and 24 were female (mean age, 40.4 years).We observed that certain patients tended to be refractory to standard therapeutic techniques of behavior therapy (exposure plus response prevention) and medication trials.^1-3 Most of these patients seemed unusual and we had started to use the term schizoobsessive to refer to them. We retrospectively examined characteristics of these treatment-resistant patients and found a high prevalence of schizotypal personality