Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia

Eryılmaz, Gül; Sayar, Gökben Hızlı; Özten, Eylem; Gül, Işıl Göğcegöz; Karamustafalıoğlu, Oğuz

doi:10.1186/1744-859x-12-40

Cited by 22 publications

(11 citation statements)

References 18 publications

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“…Aripiprazole is a second-generation antipsychotic with few trials already carried out showing its effectiveness in treating Clozapine induced OCS in TRS. TRS patients who received the combination of Aripiprazole-Clozapine not only had reduced total YBOCS score at one month after treatment, but also showed better tolerability 47 and improvement in quality of life 48 as compared to Clozapine-placebo group 49 . In fact, by adding on a Selective Serotonin Reuptake Inhibitor (SSRI) it is more effective in treating induced OCS, in cases of treatmentresistant schizophrenia which normally only responds to clozapine.…”

Section: Discussionmentioning

confidence: 98%

The effect of obsessive compulsive symptoms on psychopathology in patients with schizophrenia

Seng¹,

Yee²,

Danaee³

et al. 2018

Arch. Clin. Psychiatry (São Paulo)

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Background: There is a growing interest on the impact of comorbid obsessive-compulsive symptoms (OCS) on the course and severity of schizophrenia in recent years. Objectives: This study determined the prevalence of OCS in schizophrenia patients and the clinical outcomes of the comorbidity. Methods: A total of 220 schizophrenia patients were recruited. All the participants completed Structure Clinical Interview version, Yale Brown Obsessive Compulsive Scale, Calgary Depression Scale for Schizophrenia, Columbia Suicide Severity Rating Scale and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). Results: Significantly higher number of schizophrenia patients with OCS were taking Clozapine (p = 0.023) and antidepressants (p = 0.013). Schizophrenia patients with OCS showed more severe positive (p < 0.001) and general symptoms (p < 0.001) of schizophrenia, higher depressive symptoms (p = 0.013), higher suicidality (p < 0.001), more hospitalization (p = 0.044), poorer physical (p = 0.034) and psychological (p = 0.032) domain in WHOQOL-BREF. Discussion: Schizophrenia patients with OCS are associated with more severe psychopathology and depressive symptoms which subsequently suffered poorer physical and psychological health. Hence, recognition of OCS in schizophrenia and early initiation of effective treatment may be able to reduce the burden for people with chronic mental illness.

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Section: Discussionmentioning

confidence: 98%

The effect of obsessive compulsive symptoms on psychopathology in patients with schizophrenia

Seng¹,

Yee²,

Danaee³

et al. 2018

Arch. Clin. Psychiatry (São Paulo)

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“…Based on our current knowledge, pharmacological combination and augmentation strategies have been suggested to improve comorbid OCS according to timely reviews [ 74 , 108 ]. To address possible proobsessive effects of predominantly antiserotonergic SGAs, the add-on of mainly dopaminergic SGAs such as AMS and APZ has been proposed [ 186 – 190 , 196 , 210 , 211 ]. Within augmentation approaches, the treatment with serotonergic antidepressants has been evaluated, for example, with the tricyclic antidepressant clomipramine [ 175 ] or with the SSRI fluvoxamine [ 98 , 212 , 213 ].…”

Section: Discussion Of Research Perspectivesmentioning

confidence: 99%

Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment

Zink

2014

Advances in Medicine

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Insight into the biological pathomechanism of a clinical syndrome facilitates the development of effective interventions. This paper applies this perspective to the important clinical problem of obsessive-compulsive symptoms (OCS) occurring during the lifetime diagnosis of schizophrenia. Up to 25% of schizophrenia patients suffer from OCS and about 12% fulfil the diagnostic criteria of obsessive-compulsive disorder (OCD). This is accompanied by marked subjective burden of disease, high levels of anxiety, depression and suicidality, increased neurocognitive impairment, less favourable levels of social and vocational functioning, and greater service utilization. Comorbid patients can be assigned to heterogeneous subgroups. It is assumed that second generation antipsychotics (SGAs), most importantly clozapine, might aggravate or even induce second-onset OCS. Several epidemiological and pharmacological arguments support this assumption. Specific genetic risk factors seem to dispose patients with schizophrenia to develop OCS and risk-conferring polymorphisms has been defined in SLC1A1, BDNF, DLGAP3, and GRIN2B and in interactions between these individual genes. Further research is needed with detailed characterization of large samples. In particular interactions between genetic risk constellations, pharmacological and psychosocial factors should be analysed. Results will further define homogeneous subgroups, which are in need for differential causative interventions. In clinical practise, schizophrenia patients should be carefully monitored for OCS, starting with at-risk mental states of psychosis and longitudinal follow-ups, hopefully leading to the development of multimodal therapeutic interventions.

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“…Some of these drugs can potentially influence obsessive symptoms. For instance, clozapine augmentation with aripiprazole is common for persistent psychotic symptoms (Cardinal et al 2015 ) but can also be added as therapy for OCD (Englisch et al 2009 ; Eryılmaz et al 2013 ), sedation (Perdigués et al 2016 ) or metabolic complications (Zimbron et al 2016 ). Similarly, antidepressants are primarily used for depression, anxiety or OCD.…”

Section: Methodsmentioning

confidence: 99%

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

et al. 2018

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BackgroundObsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions.MethodsThe electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined.ResultsOCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity.ConclusionsScreening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients.

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Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia

Cited by 22 publications

References 18 publications

The effect of obsessive compulsive symptoms on psychopathology in patients with schizophrenia

The effect of obsessive compulsive symptoms on psychopathology in patients with schizophrenia

Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

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