Clozapine and Obsessions in Patients With Recent-Onset Schizophrenia and Other Psychotic Disorders

Synergistic Action of 5-HT2A Antagonists and Selective Serotonin Reuptake Inhibitors in Neuropsychiatric Disorders

“…The magnitude of this clinical problem remains to be fully explored as clozapine may be implicated more frequently than other antipsychotic drugs (De Haan et al, 1999). Obsessive-compulsive symptoms have been reported to be improved in schizophrenic patients treated with olanzapine (Poyurovsky et al, 2000).…”

A 44-Year-Old Woman with Intrusive Thoughts

“…In this study, there was a significant relationship between the use of clozapine and the worsening or emergence of OCS: 20.6% of patients on clozapine developed OCS compared with 1.3% of patients treated with other antipsychotic medications (typical antipsychotics and risperidone). 6 In a comparison of patients receiving haloperidol or clozapine, Sa and colleagues 3 did not find a statistically significant difference in the prevalence of OCS in patients receiving haloperidol vs. clozapine. However, they found that patients receiving clozapine had a significantly greater severity of OCS, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS total score of 21.5 vs. 12.7).…”

“…1,2 Comorbid OCD/ OCS with schizophrenia has been associated with significantly worse positive and negative symptoms 3 and significantly worse motor dysfunction 2 when compared with patients with schizophrenia without OCD/OCS. Although the exact relationship remains unclear, explanations for this commonly identified comorbidity include: 1) comorbid OCS and schizophrenia patients may represent a pathophysiological subgroup of patients with schizophrenia 4 ; 2) OCS and schizophrenia may share a common genetic predisposition 5 ; 3) OCS may be induced by treatment of schizophrenia with atypical antipsychotics 6 ; and 4) previously existing OCS may be exacerbated by treatment with atypical antipsychotics. 3,6 Use of antiserotonergic atypical antipsychotics has been implicated in association with OCS theoretically related to antagonism of the 5HT2 receptors.…”

“…Although the exact relationship remains unclear, explanations for this commonly identified comorbidity include: 1) comorbid OCS and schizophrenia patients may represent a pathophysiological subgroup of patients with schizophrenia 4 ; 2) OCS and schizophrenia may share a common genetic predisposition 5 ; 3) OCS may be induced by treatment of schizophrenia with atypical antipsychotics 6 ; and 4) previously existing OCS may be exacerbated by treatment with atypical antipsychotics. 3,6 Use of antiserotonergic atypical antipsychotics has been implicated in association with OCS theoretically related to antagonism of the 5HT2 receptors. 7 Clozapine specifically has been cited in association with OCS in a number of case reports.…”

“…De Haan and colleagues 6 conducted a retrospective cohort study case challenge of 121 patients admitted with psychotic disorders, 91 of whom were diagnosed with schizophrenia and 17 with schizoaffective disorder. In this study, there was a significant relationship between the use of clozapine and the worsening or emergence of OCS: 20.6% of patients on clozapine developed OCS compared with 1.3% of patients treated with other antipsychotic medications (typical antipsychotics and risperidone).…”