Obsessive‐compulsive symptoms: a side‐effect of antipsychotic treatment

Abstract

Obsessive‐compulsive symptoms (OCS) secondary to antiserotonergic antipsychotic treatment of schizophrenia appear to have a significant prevalence from previous studies but can be very difficult to detect as they are overshadowed by the diagnosis of schizophrenia. Here, the authors describe three cases where patients have developed OCS after starting risperidone in one case, and clozapine in two other cases and how significant improvements can be achieved with SSRIs and, if necessary, cognitive behavioural therapy (CBT).

Clozapine-Associated Obsessive-Compulsive Symptoms and Their Management: A Systematic Review and Analysis of 107 Reported Cases

“…Of the 59 cases where antidepressants were added without simultaneously changing the dose of clozapine or adding other medications to treat OCS, 29 patients (49.2%) improved [17, 19-21, 27, 29, 30, 32-34, 36, 39, 48, 53, 60, 64, 65, 70, 72], whereas 30 patients (50.8%) demonstrated inadequate response to an initial trial of SSRI/ clomipramine [20,22,25,35,37,42,43,45,46,49,50,54,55,59,60,63,[66][67][68][69]71].…”

“…Twenty-five non-responders underwent additional trials to treat their OCS. Eleven non-responders underwent trials with different antidepressants [22,35,37,42,55,59,60,[67][68][69]71], of whom only 2 patients responded (18.2%) [37,67]. Sixteen (64.0%) non-responders showed improvement without psychotic exacerbation following a decrease in the dose of clozapine [42,45,46,49,55,59,60,66,68], of whom 8 (50.0%) were concomitantly treated with aripiprazole [49,55], 2 with antidepressants [59,66], 2 with both aripiprazole and antidepressant [42,45], and 1 with valproic acid [46].…”

“…DOI: 10.1159/000505876 done) [44,50,51,53,59,66,68], OCS improved in 1 case using amisulpride while simultaneously reducing the dose of clozapine [50] and in another case using ziprasidone without simultaneous clozapine dose modification [44]. Of the 18 cases that added aripiprazole (i.e., a partial D 2 receptor agonist) [42,45,49,55,58,67,68], OCS improved in 11 cases while simultaneously reducing the dose of clozapine [42,45,49,55] and in another 5 cases without simultaneous clozapine dose modification [55,58]. Adding aripiprazole without reducing the dose of clozapine was associated with a higher rate of response (n = 5/7; 71.4%) than adding a D 2 antagonist without changing the dose of clozapine (n = 1/6; 16.7%) but did not reach significance (Fisher, p = 0.103).…”

“…Other Pharmacological or Nonpharmacological Treatments Of the 5 cases that utilized valproate [46,51,57,68], OCS improved in 2 cases while simultaneously reducing the dose of clozapine [46,51] and in another case, without simultaneous clozapine dose modification [57]. Nine cases utilized cognitive behavioral therapy (CBT) [49,67,68], 2 cases utilized behavioral therapy [38,46], and 1 case utilized distraction techniques in combination with sertraline [64]. Significant improvement in OCS was noted in 1 case that utilized behavioral therapy [38] and in the case that utilized distraction techniques in combination with sertraline [64].…”