Meta-analysis of cognitive functioning in patients with psychotic disorders and obsessive-compulsive symptoms

Obsessive-compulsive symptoms (OCS) in psychotic disorders are associated with unfavorable outcomes, whether this extends to cognitive function remains unclear. We conducted meta-analyses on several cognitive domains to investigate overall group differences between patients with a psychotic disorder and co-occurring OCS (OCS +) and those without OCS (OCS-). We used meta-regression to assess possible confounding effects. No overall associations between OCS + and OCS- in any of the 17 investigated cognitive domains were found. We predominantly found large heterogeneity in effect size and direction among studies. Post-hoc analyses of processing speed tasks not purely based on reaction-time showed worse performance in the OCS + group with a small effect size (SMD = - 0.190;p = 0.029). Meta-regression revealed advanced age was significantly correlated with worse performance of the OCS + group in processing speed (R-2 = 0.7), working memory (R-2 = 0.11), cognitive inhibition (R-2 = 0.59), and cognitive flexibility (R-2 = 0.34). Patients fulfilling the criteria for an obsessive-compulsive disorder showed less impairment in cognitive inhibition compared to the OCS + group (R-2 = 0.63). Overall, comorbid OCS were not associated with cognitive impairment. However, large heterogeneity between studies highlights the complex nature of factors influencing cognition in people with psychotic disorder and comorbid OCS and warrants further research into possible moderating factors.

Automated summary

The presence of obsessive-compulsive symptoms in patients with psychotic disorders does not seem to be directly associated with cognitive impairment in overall cognitive domains. However, post-hoc analyses reveal worse performance in processing speed tasks for patients with co-occurring OCS, and meta-regression suggests that age plays a significant role in the cognitive performance of this group. The heterogeneity in study results underscores the need for further research into the complex factors influencing cognition in individuals with psychotic disorders and comorbid OCS.