Obsessive-Compulsive Symptoms and Other Symptoms of the At-risk Mental State for Psychosis: A Network Perspective

Hui Lin Ong, Adela Maria Isvoranu*, Frederike Schirmbeck, Philip McGuire, Lucia Valmaggia, Matthew J. Kempton, Mark Van Der Gaag, Anita Riecher-Rössler, Rodrigo A. Bressan, Neus Barrantes-Vidal, Barnaby Nelson, G. Paul Amminger, Patrick McGorry, Christos Pantelis, Marie Odile Krebs, Merete Nordentoft, Birte Glenthøj, Stephan Ruhrmann, Gabriele Sachs, Bart P.F. RuttenJim Van Os, Lieuwe De Haan, Denny Borsboom, Maria Calem, Stefania Tognin, Gemma Modinos, Sara Pisani, Emily Hedges, Eva Velthorst, Tamar C. Kraan, Daniella S. Van Dam, Nadine Burger, Athena Politis, Joanne Goodall, Stefan Borgwardt, Erich Studerus, Ary Gadelha, Elisa Brietzke, Graccielle Asevedo, Elson Asevedo, Andre Zugman, Tecelli Domínguez-Martínez, Manel Monsonet, Lidia Hinojosa, Anna Racioppi, Thomas R. Kwapil, Mathilde Kazes, Claire Daban, Julie Bourgin, Olivier Gay

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


Background: The high prevalence of obsessive-compulsive symptoms (OCS) among subjects at Ultra-High Risk (UHR) for psychosis is well documented. However, the network structure spanning the relations between OCS and symptoms of the at risk mental state for psychosis as assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS) has not yet been investigated. This article aimed to use a network approach to investigate the associations between OCS and CAARMS symptoms in a large sample of individuals with different levels of risk for psychosis. Method: Three hundred and forty-one UHR and 66 healthy participants were included, who participated in the EU-GEI study. Data analysis consisted of constructing a network of CAARMS symptoms, investigating central items in the network, and identifying the shortest pathways between OCS and positive symptoms. Results: Strong associations between OCS and anxiety, social isolation and blunted affect were identified. Depression was the most central symptom in terms of the number of connections, and anxiety was a key item in bridging OCS to other symptoms. Shortest paths between OCS and positive symptoms revealed that unusual thought content and perceptual abnormalities were connected mainly via anxiety, while disorganized speech was connected via blunted affect and cognitive change. Conclusions: Findings provide valuable insight into the central role of depression and the potential connective component of anxiety between OCS and other symptoms of the network. Interventions specifically aimed to reduce affective symptoms might be crucial for the development and prospective course of symptom co-occurrence.

Original languageEnglish
Pages (from-to)1018-1028
Number of pages11
JournalSchizophrenia Bulletin
Issue number4
Publication statusPublished - 1 Jul 2021


  • anxiety
  • clinical high risk
  • depression
  • network analysis
  • obsessive-compulsive
  • psychosis
  • ultra-high risk


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