Obsessive-Compulsive Symptoms in Early and Very Early-Onset Schizophrenia: A Retrospective Study from the University Child and Adolescent Psychiatry Department of Casablanca

Recent findings suggest that up to 30% of patients with schizophrenia exhibit obsessive-compulsive symptoms (OCS), which may emerge as prodromal signs, co-occur with schizophrenia, or be induced by antipsychotic treatment. These patients often present with higher suicide risk, greater cognitive control difficulties, and more severe depressive symptoms. Despite this, few studies have explored OCS in children and adolescents with schizophrenia. This retrospective study aimed to describe and compare the sociodemographic and clinical profiles of children and adolescents diagnosed with schizophrenia, with or without comorbid OCS, and to analyze the impact of OCS on clinical and therapeutic features, functioning, prognosis and quality of life. Medical records from 2021 to 2023 were reviewed at the Child and Adolescent Psychiatry Department in Casablanca, Morocco, including 102 patients aged 8 to 18 years diagnosed with schizophrenia, among whom 42 had comorbid OCS. Patients followed exclusively for OCD without schizophrenia were excluded. The mean age was 14 years (SD = 2.45), with a sex ratio of 2:1 (male:female). The presence of OCS was significantly associated with more delusions (p = 0.042), intrapsychic hallucinations (p = 0.043), and disorganized speech (p = 0.049). Additionally, 60% of patients with OCS had dropped out of school, 64% exhibited aggressive behavior, and 14% had attempted suicide. These findings suggest that OCS in the context of early-onset schizophrenia is linked to a more severe clinical profile and functional impairment. The distinction between OCS as a comorbidity or a specific schizophrenia subtype remains unresolved. Early identification and treatment of OCS may help prevent complications and improve long-term outcomes.