title: Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence.
abstract: OBJECTIVE
  To review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Our results support the use of CBT for OCD in patients with psychosis.
authors.affiliation: Antonio Tundo, Roberta Necci, Istituto di Psicopatologia, 00196 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Tundo
authors.affiliation: Antonio Tundo, Roberta Necci, Istituto di Psicopatologia, 00196 Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Necci
keywords: Clozapine; Cognitive behavioural therapy; Obsessive compulsive disorder; Obsessive compulsive symptoms; Schizoaffective disorder; Schizophrenia; Second-generation antipsychotic