Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Abstract

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.

A cross sectional study of impact and clinical risk factors of antipsychotic-induced OCD

“…It is of note that we covered the prevalence and complex phenomenology of obsessions and compulsions in clozapine-treated patients in a previous work (Fernandez-Egea et al, 2018). Here, we use the term OCD to define these phenomena, albeit acknowledging the open debate about its pathophysiology and correct terminology.…”

“…Routine clinical assessments are described elsewhere (Fernandez-Egea et al, 2018) and include full psychiatric history, comprehensive mental state examination, current medication list, smoking habit, legal and illegal drug history, early life history, clozapine treatment length and side effects assessment and physical health assessment. Among others, psychopathological scales included assessment for general functioning [Global Assessment of Functioning (GAF)](Haro et al, 2003), short version of the Warwick-Edinburgh Wellbeing Scale [SWEWBS](Brown et al, 2016) and symptom severity using the Clinical Global Impression (CGI) for Schizophrenia (Busner and Targum, 2007) which includes 5 domains (positive, negative, cognitive, and depressive) rating from 1 to 7 for absence to extreme severity.…”

“…Schizophrenia and obsessive-compulsive disorder (OCD) are frequently comorbid (McGlashan, 1984). Several studies have shown that schizophrenia patients treated with second generation antipsychotics will develop symptoms of obsessive-compulsive disorder (OCD) (Schirmbeck and Zink, 2012) with the proportion being around half (Fernandez-Egea et al, 2018). To date, no replicated clinical risk factors have been found that help to identify vulnerable cases prior to treatment initiation.…”

“…One potential explanation of the lack of clinical risk factors for developing OCD in antipsychotic-treated patients could be the mis-identification of cases. In a recent report by Fernandez-Egea et al (2018) using a large cohort of clozapine treated patients, we identified a few factors that might have acted as confounders in prior studies. For instance, we found rising OCD prevalence and checking compulsion to be associated with increasing years of treatment.…”

Assessment of obsessive-compulsive disorder comorbidity and obsessive-compulsive symptom dimensions in patients with schizophrenia

“…Age, gender, marital status, and education level did not show a significant difference between the 3 groups, which was consistent with most of the previous studies. 3,4 On the other hand, some studies reported a significant relationship between the sociodemographic variables and OCD presence in schizophrenia. 11 There was no significant difference between 3 groups in terms of the duration of schizophrenia.…”