Obsessive-Compulsive Symptoms in Patients With Schizophrenia

Beduin, Albertine A. Scheltema; Swets, Marije; Machielsen, Marise W. J.; Korver, Nikie

doi:10.4088/jcp.11m07164

Cited by 46 publications

(10 citation statements)

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“…Length of clozapine treatment is a replicated risk factor for developing OCD (Lin et al 2006 ; Boyette et al 2011 ; Schirmbeck et al 2011 ; Scheltema Beduin et al 2012 ). However, the evidence for OCD being a clozapine dose-dependent side effect is still inconclusive.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

et al. 2018

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“…Some authors suggested that in these cases OCS might be considered an adverse event of SGA and introduced the term “antipsychotic-induced OCS” or “secondary OCS” (s-OCS)[5,10]. Nevertheless, because sometimes OCS occur or worsen also under no treatment or treatment with first-generation antipsychotics which are not primarily 5HT2-R-antagonistic[11], an interaction between genetic/biological predispositions, psychosocial factors and treatments could better explain the phenomenon[12]. …”

Section: Introductionmentioning

confidence: 99%

Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence

Tundo

Necci

2016

WJP

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AIMTo review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODSIn this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder (OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubMed search using as search string (“obsessive compulsive disorders” or “obsessive compulsive symptoms”) and (“schizophrenia” or “schizoaffective disorder” or “psychosis”) and (“cognitive behavioural therapy”). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.RESULTSThe reviewed evidence indicates that CBT is: (1) safe, i.e., does not worsen psychotic symptoms; (2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity; (3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD co-occurring with psychosis; and (4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by second-generation antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.CONCLUSIONOur results support the use of CBT for OCD in patients with psychosis.

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“…Clozapine is not recommended for OCD based on one small open-label trial that failed to demonstrate benefit [ 19 ]. Additionally, clozapine has been described to induce or worsen OCS/OCD in mostly small studies and case reports involving patients with a primary psychotic disorder [ 5 , 20 , 21 ]. In psychotic illnesses, clozapine-induced OCS should not be a reason for discontinuation when clear benefits for decreasing psychosis occur.…”

Section: Discussionmentioning

confidence: 99%

Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms

Leung

Palmer

2016

Case Reports in Psychiatry

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One underrecognized adverse event of clozapine is the emergence or worsening of obsessive-compulsive symptoms (OCS). OCS, particularly violent thoughts, can be inaccurately described as psychosis and result in a misdiagnosis. We report a case of a 42-year-old man, initially diagnosed with schizoaffective, who was placed on clozapine for the management of “violent delusions.” However, clozapine led to a worsening of these violent thoughts resulting in suicidal ideation and hospitalization. After exploration of the intrusive thoughts and noting these to be egodystonic, clearly disturbing, and time consuming, an alternative diagnosis of obsessive-compulsive disorder (OCD) was made. Clozapine was inevitably discontinued resulting in a significant reduction of the intrusive thoughts without emergence of psychosis or adverse events. While an overlapping phenomenology between OCD and psychotic disorders has been described, clozapine and other antiserotonergic antipsychotics have been implicated with the emergence or worsening of OCS. Unique to our case is that the patient's obsessions had been treated as psychosis leading to the inadequate treatment of his primary illness, OCD. This case highlights the potential for OCD to masquerade as a psychotic disorder and reminds clinicians that clozapine may worsen OCS.

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Obsessive-Compulsive Symptoms in Patients With Schizophrenia

Cited by 46 publications

References 0 publications

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence

Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms

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