Critical Review of the Use of Second-Generation Antipsychotics in Obsessive–Compulsive and Related Disorders

Abstract

Currently, all second-generation antipsychotics are approved for schizophrenia. Many are also approved for bipolar disorder, with some also approved as adjunctive treatment for depression and autism-related irritability. Second-generation antipsychotics are increasingly being prescribed for indications other than those approved by the Food and Drug Administration, such as in dementia, anxiety, and post-traumatic stress disorder to name a few. Obsessive–compulsive and related disorders are a group of disorders characterized by preoccupation and repetitive behaviors. According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, obsessive–compulsive disorder, body dysmorphic disorder, trichotillomania, hoarding disorder, and excoriation, the latter two being newly designated disorders, fall under obsessive–compulsive and related disorders. Due to a lack of well designed clinical studies specifically addressing the use of second-generation antipsychotics in obsessive–compulsive and related disorders, it is unknown whether these agents are clinically beneficial. Current research describing the pathophysiology of these disorders shows the involvement of similar brain regions and neurotransmitters across the five obsessive–compulsive and related disorders. Despite differences in the receptor binding profiles, second-generation antipsychotics share many common pharmacodynamics properties. This review sought to examine all the published reports of second-generation antipsychotics being used in the management of symptoms of the aforementioned diseases and compile evidence for clinicians who encounter patients who are unresponsive to standard treatment.

The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?

“…Moreover, antipsychotics as a class are associated with an increased risk for side effects, including weight gain, metabolic syndrome, Parkinsonism, tardive dyskinesia, and even neuroleptic malignant syndrome. [7][8][9] Thus, there is an urgent need for new targets for treatment development.…”

Habit reversal therapy in the management of body focused repetitive behavior disorders

“…Amino Acid that restores glutamate to the nucleus accumbens Reduction of skin picking symptoms with few side effects24 23 Antipsychotics Block dopamine and serotonin receptors Reduction in hairpulling and TTM symptoms seen with certain drugs within this class 25,26 Naltrexone Modulates the dopamine in the reward pathways of the limbic system Some reports of decreased symptoms have been seen but one randomized trial showed no benefit greater than placebo 27 Inositol Intracellular phosphatidylinositol second messenger system component linked to neurotransmitter receptors…”

Psychopharmacology in dermatology: Treatment of primary psychiatric conditions in dermatology

“…Additionally, some patient may benefit from topical dermatologic therapy. The drugs with positive evidence of use in the treatment of excoriation disorder 24,[26][27][28][29][30][31][32][33][34] are presented in Table 3.…”

“…Selective serotonin reuptake inhibitors, in general, show negative results and, in case reports, have been potentiated with atypical antipsychotics. Despite their widespread use, they do not appear to be effective in trials, particularly in monotherapy 26,[30][31][32]34 are presented in Table 4.…”