Clozapine and Paroxetine in the Treatment of Schizophrenia With Obsessive-Compulsive Features

Strous, Rael D.; Patel, Jayendra K.; Zimmet, Suzanna V.; Green, Alan I.

doi:10.1176/ajp.156.6.973a

Cited by 23 publications

(8 citation statements)

References 6 publications

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“…31 However, there are a number of reports that treatment with neuroleptics and anti-OCD medications (SRIs) result in significant symptom relief and functional improvements in some patients with schizophrenia and OCD. [32][33][34]…”

Section: Discussionmentioning

confidence: 99%

Features of obsessive–compulsive disorder in patients primarily diagnosed with schizophrenia

Ohta

Kokai

Morita

2003

Psychiatry Clin Neurosci

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We investigated the prevalence of obsessive-compulsive disorder (OCD) among patients who were primarily diagnosed with schizophrenia. We investigated the differences in the neuropsychiatric features and motor symptoms between patients with schizophrenia who did or did not have OCD. Seventy-one subjects with the DSM-IV diagnosis of schizophrenia were evaluated by the Structured Clinical Interview for DSM-IV Axis I Disorders, the Yale-Brown Obsessivecompulsive Scale and the Positive and Negative Syndrome Scale. To assess their motor symptoms, the Abnormal Involuntary Movements Scale, the Barnes rating scale for drug-induced akathisia and the Simpson and Angus extrapyramidal symptoms (EPS) rating scale were used. The 13 subjects with OCD (18.3%) had significantly more severe motor symptoms than the non-OCD subjects. Patients with schizophrenia who exhibit moderate to severe motor symptoms as sideeffects of neuroleptics, should be examined for OCD comorbidity. Patients who are found to have OCD comorbidity must be treated with carefully chosen medications, including serotonin reuptake inhibitors.

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Section: Discussionmentioning

confidence: 99%

Features of obsessive–compulsive disorder in patients primarily diagnosed with schizophrenia

Ohta

Kokai

Morita

2003

Psychiatry Clin Neurosci

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“…There are several case reports and chart analyses [1, 3, 4, 7, 8,10] [12,15,16,25,26,28,34,35,38] describing the de novo appearance or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. It was suggested that CLZ-induced OC symptoms might result from the antagonistic activity of CLZ on serotonin receptors [3,7,10,28,34]. It has been reported that some schizophrenic patients with prominent OC symptoms might benefit from the addition of selective and nonselective SRIs to CLZ [8, 28,34].…”

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confidence: 99%

“…It was suggested that CLZ-induced OC symptoms might result from the antagonistic activity of CLZ on serotonin receptors [3,7,10,28,34]. It has been reported that some schizophrenic patients with prominent OC symptoms might benefit from the addition of selective and nonselective SRIs to CLZ [8, 28,34]. However, some reports describe a positive effect of CLZ monotherapy in OC schizophrenic patients [3,7,11,24,30,35,36,38,40].…”

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Clozapine in the Treatment of Obsessive-compulsive Symptoms in Schizophrenia Patients: A Case Series Study

2004

Pharmacopsychiatry

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“…Fur ther, it seems to trig ger ob sessive-com pul sive symp toms in pa tients af fected by schizophre nia (9,10). Con versely, there are re ports of pa tients with schizo phre nia as so ci ated with ob ses sive-com pul sive symptoms who do re spond to a com bi na tion of clo zap ine and an SSRI (11).…”

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Olanzapine Augmentation of Serotonin Uptake Inhibitors in Obsessive—Compulsive Disorder: An Open Study

Francobandiera¹

2001

Can J Psychiatry

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Ob jec tive:This study evalu ates the clini cal re sponse to ol an zap ine used in as so cia tion with se lec tive se ro tonin re up take in hibitors (SSRIs) O b ses sive-com pul sive dis or der (OCD) is a chronic and of ten dis abling dis ease. Pa tients af fected by OCD of ten do not re spond to spe cific phar ma col ogi cal treat ments: despite the ef fec tive ness of clo mi pramine and se lec tive se rotonin re up take in hibi tors (SSRIs) such as par oxet ine, cita lo pram, ser tra line, fluoxet ine, and fluvox am ine, ap proximately 40% to 60% of pa tients who re ceive an ade quate treatment with these agents are clini cally un changed (1). Thus, al ter na tive strate gies are needed. In this re gard, the as so ciation of neu ro lep tics such as ha loperi dol (2) and pi mozide (3) ap pears to be a po ten tially use ful strat egy for a sub group of pa tients, es pe cially those with comor bid chronic tic dis or ders (such as Tourette syn drome) or schi zo typal per son al ity dis order (4). Al though, how ever, this strat egy has been shown to be ef fec tive for up to 65% of SSRI-refractory pa tients with OCD (2), the chronic ad mini stra tion of tra di tional an tipsychot ics of ten leads to such un de sir able side ef fects as tar dive dyski ne sia. To pre vent the on set of these phe nom ena and to in crease pa tients' com pli ance, atypi cal neu ro lep tics (drugs with a safer side-effects pro file) have been in ves ti gated in the man age ment of this dis or der.Risperi done has shown ef fi cacy as ad junc tive treat ment in SSRI-refractory OCD (5,6), but these stud ies were per formed on small sam ples with an open-label de sign. The only double-blind, placebo-controlled study (7) sug gested that patients with OCD may re spond to risperi done aug men ta tion of on go ing fluvox am ine treat ment and that comor bid ity for tics or schi zo typal per son al ity dis or der was not a pre dic tor.Clo zap ine treat ment was found to be in ef fec tive in cases of re frac tory OCD (8). Fur ther, it seems to trig ger ob sessive-com pul sive symp toms in pa tients af fected by schizophre nia (9,10). Con versely, there are re ports of pa tients with schizo phre nia as so ci ated with ob ses sive-com pul sive symptoms who do re spond to a com bi na tion of clo zap ine and an SSRI (11).Pub lished data on ol an zap ine aug men ta tion in cases of treatment-resistant OCD in clude 2 let ters (12,13) and an open-label study (14) car ried out by the same group. These authors con cluded that ol an zap ine may ef fec tively aug ment an on go ing SSRI medi ca tion in the treat ment of re frac tory OCD but that there is a sub group of pa tients who do not respond to this as so cia tion.We also, how ever, found re ports sug gest ing the pos si ble onset of ob ses sive symp toms in pa tients af fected by schizo phrenia who were treated with ol an zap ine alone (15,16). The pur pose of this study is there fore to evalu ate the ef fect of olan zap ine aug men ta tion in the man age ment of SSRI-resistant OCD. MethodsThe sub j...

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Clozapine and Paroxetine in the Treatment of Schizophrenia With Obsessive-Compulsive Features

Cited by 23 publications

References 6 publications

Features of obsessive–compulsive disorder in patients primarily diagnosed with schizophrenia

Features of obsessive–compulsive disorder in patients primarily diagnosed with schizophrenia

Clozapine in the Treatment of Obsessive-compulsive Symptoms in Schizophrenia Patients: A Case Series Study

Olanzapine Augmentation of Serotonin Uptake Inhibitors in Obsessive—Compulsive Disorder: An Open Study

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