In Reply

SIR: Drs. Reznik and Kotler thoughtfully discuss in their letter the theoretical possibility of different subgroups of persons with schizophrenia with obsessive-compulsive symptoms (OCS). Going further than many others, they suggest that the presence of OCS in schizophrenia may have a different meaning, depending on whether the OCS appeared before or after onset of traditional symptoms. In other words, while others have suggested that OCS may mark a subtype of schizophrenia, these authors suggest there may be two different groups of persons with schizophrenia and OCS. This distinction may prove useful because, as implied in their letter, the current literature has been quite confusing, given that some researchers find the presence of OCS linked with better outcome, while others find the opposite (Borkowska, Pilaczynska, & Rybakowski, 2003; Hwang, M.Y., Morgan, & Losconzcy, 2000; Whitney, Fastaneau, Evans & Lysaker, 2004). The possibility that there are at least two subgroups of persons with schizophrenia and OCS is also supported by a recent cluster analysis, in which we found two distinct groups of persons with schizophrenia and OCS: one with particularly good psychosocial function and one with especially poor neurocognitive function (Lysaker, Lancaster, Nees, & Davis, 2004). While they remain a matter of conjecture at present, the notions of Dr. Reznik and Kotler can be easily tested and if confirmed may help unravel a piece of the complexity of schizophrenia.