Effects of Antipsychotic Treatment on Obsessive-Compulsive Symptoms

Schirmbeck, Frederike; Zink, Mathias

doi:10.1007/978-3-319-12952-5_10

Cited by 9 publications

(6 citation statements)

References 154 publications

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“…Furthermore, the development of de novo OCS under antipsychotic medication, especially clozapine, has been increasingly acknowledged [ 60 , 61 ]. Considering this effect within our data, more patients in the de novo and persistent groups were treated with clozapine when compared to individuals in the no-OCS group.…”

Section: Discussionmentioning

confidence: 99%

Obsessive–compulsive symptoms and overall psychopathology in psychotic disorders: longitudinal assessment of patients and siblings

Schirmbeck

Swets

Meijer

et al. 2016

Eur Arch Psychiatry Clin Neurosci

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The course of obsessive–compulsive symptoms (OCS) and its association with alterations in other clinical variables in patients with psychotic disorders is insufficiently known. Patients (n = 602) and unaffected siblings (n = 652) from the Dutch Genetic Risk and Outcome of Psychosis (GROUP) study were investigated at baseline and after 3 years. Participants were assigned to four groups based on the course of OCS over time: no-OCS, persistent OCS, initial OCS and de novo OCS. In addition to cross-sectional comparisons, longitudinal associations between changes in OCS and symptoms of schizophrenia and general functioning were investigated. Patients with co-occurring OCS reported significantly higher severity of psychotic and affective symptoms as well as lower overall functioning compared to patients without OCS. These differences were stable over time for patients reporting persistent OCS. Subsequent repeated measure analysis revealed significant interaction effects for groups reporting changes in their OCS. Whereas the group with remission of initial OCS showed significant improvement in positive symptoms, emotional distress and functioning, the de novo group showed no significant change in these variables, but rather reported stable higher psychopathology. Similar results were found on a subclinical level in siblings. Patients with co-occurring OCS present a more severe clinical picture, especially if symptoms persist over time. The remission of OCS was associated with overall improvement, whereas individuals with de novo OCS already reported higher clinical impairment before OCS onset. More research is needed to elucidate causal pathways and to develop effective interventions for persistent comorbid OCS.Electronic supplementary materialThe online version of this article (doi:10.1007/s00406-016-0751-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Obsessive–compulsive symptoms and overall psychopathology in psychotic disorders: longitudinal assessment of patients and siblings

Schirmbeck

Swets

Meijer

et al. 2016

Eur Arch Psychiatry Clin Neurosci

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“…On the other hand, atypical antipsychotics (such as clozapine and olanzapine) have been known to cause/worsen the OC symptoms. [ 7 ] Among the antipsychotics, olanzapine has been found to be less effective in the treatment of BPAD-OCD. [ 8 ] However, this was not the case in our patient who responded well to olanzapine leading to complete remission of mania.…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of a Case of Obsessive-compulsive Disorder Comorbid with Bipolar Affective Disorder

Chandran¹,

Parmar²,

Deb³

2017

Indian Journal of Psychological Medicine

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Obsessive–compulsive disorder (OCD) is a chronic illness with waxing and waning course. OCD is not uncommonly found to be comorbid with bipolar affective disorder (BPAD). The course and prognosis of OCD have distinctive features in such cases. Only rarely symptoms of OCD emerge during mania in such individuals. We hereby report a very unusual case of OCD comorbid with BPAD in which obsession and compulsion symptoms occurred only during manic episodes with complete remission during periods between manic episodes (including during depressive episodes).

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“…This heterogeneity suggests multiple interacting pathways [8]. For the subgroup of patients, who develop OCS subsequent to their first psychotic episode and initiation of antipsychotic treatment, increasing evidence strongly suggests a “pro-obsessive” effect of certain second-generation antipsychotics (SGAs), especially clozapine [9, 10] and olanzapine [11]. Clozapine, and similarly olanzapine, exerts its effects via a relatively low affinity to dopamine D 2 receptors combined with strong antagonism at 5-HT 1C , 5-HT 2A and 5HT 2C receptors [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Reduced activity and connectivity of left amygdala in patients with schizophrenia treated with clozapine or olanzapine

Mier

Schirmbeck

Stoessel

et al. 2018

Eur Arch Psychiatry Clin Neurosci

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Obsessive–compulsive symptoms (OCS) in patients with schizophrenia are a common co-occurring condition, often associated with additional impairments. A subgroup of these patients develops OCS during treatment with second-generation antipsychotics (SGAs), most importantly clozapine and olanzapine. So far, little is known about possible neural mechanism of these SGAs, which seem to aggravate or induce OCS. To investigate the role of SGA treatment on neural activation and connectivity during emotional processing, patients were stratified according to their monotherapy into two groups (group I: clozapine or olanzapine, n = 20; group II: amisulpride or aripiprazole, n = 20). We used an fMRI approach, applying an implicit emotion recognition task. Group comparisons showed significantly higher frequency and severity of comorbid OCS in group I than group II. Task specific activation was attenuated in group I in the left amygdala. Furthermore, functional connectivity from left amygdala to right ventral striatum was reduced in group I. Reduced amygdala activation was associated with OCS severity. Recent literature suggests an involvement of an amygdala–cortico–striatal network in the pathogenesis of obsessive–compulsive disorder. The observed differential activation and connectivity pattern of the amygdala might thus indicate a neural mechanism for the development of SGA-associated OCS in patients with schizophrenia. Further neurobiological research and interventional studies are needed for causal inferences.

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Effects of Antipsychotic Treatment on Obsessive-Compulsive Symptoms

Cited by 9 publications

References 154 publications

Obsessive–compulsive symptoms and overall psychopathology in psychotic disorders: longitudinal assessment of patients and siblings

Obsessive–compulsive symptoms and overall psychopathology in psychotic disorders: longitudinal assessment of patients and siblings

A Rare Presentation of a Case of Obsessive-compulsive Disorder Comorbid with Bipolar Affective Disorder

Reduced activity and connectivity of left amygdala in patients with schizophrenia treated with clozapine or olanzapine

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