Abstract
<title>Abstract</title> <p>Background The co-occurrence of schizophrenia-spectrum psychosis and obsessive-compulsive symptoms presents diagnostic and therapeutic challenges. Although often described in the literature as a schizo-obsessive presentation, this term is descriptive and does not represent a formal DSM-5 diagnostic subtype. Case Presentation: A 24-year-old Somali male presented with a 6-month history of auditory hallucinations, paranoid delusions, and severe compulsive rituals, including repetitive handwashing, lock-checking, and counting behaviors. There was no family history of psychiatric illness, substance use, neurological illness, or major medical comorbidity. Clinical evaluation, laboratory investigations, and brain CT scan did not suggest an organic cause. Baseline assessment showed severe psychotic and obsessive-compulsive symptoms, with a PANSS score of 92 and a Y-BOCS score of 32/40. Intervention: The patient was treated with risperidone, initiated at 2 mg/day and titrated to 6 mg/day over two weeks, together with fluvoxamine, initiated at 50 mg/day and gradually increased to 200 mg/day over four weeks. Psychotherapy included cognitive-behavioral therapy with structured exposure and response prevention targeting contamination fears, checking rituals, and counting behaviors. Outcomes: Over 12 weeks of follow-up, the patient showed marked clinical improvement. PANSS decreased from 92 at baseline to 54 by week 8 and 42 by week 12, while Y-BOCS decreased from 32/40 at baseline to 22 by week 6 and 14 by week 12. Improvements were accompanied by reduced hallucinations, fewer compulsive rituals, better daily functioning, good adherence, and no major reported adverse effects. Discussion This case highlights the importance of multimodal treatment, including antipsychotic medication, SSRI therapy, ERP-based psychotherapy, psychoeducation, and family involvement in managing complex psychosis with obsessive-compulsive features. Conclusion Integrating pharmacological therapy, behavioral interventions, culturally sensitive psychoeducation, and family engagement can achieve meaningful short-term outcomes in schizophrenia-spectrum psychosis with obsessive-compulsive symptoms in low-resource settings.</p>