Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses

Laroche, Diane Grillault; Gaillard, Adeline

doi:10.1016/j.psychres.2016.09.031

Cited by 32 publications

(18 citation statements)

References 102 publications

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“…Obsessive–compulsive disorder (OCD) is common in schizophrenia patients treated with antipsychotics with significant anti-serotoninergic action (Swets et al 2014 ; Grillault Laroche & Gaillard, 2016 ). Clozapine was the first drug reported (Baker et al 1992 ) and is still the medication more frequently associated with OCD (Poyurovsky et al 2001 ), along with olanzapine (Schirmbeck et al 2011 ).…”

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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“…Predominant anti-serotonergic profile (both 5-HT2A and 5-HT2C receptor antagonism) of certain SGAs such as clozapine and risperidone is hypothesized to be responsible for inducing OCS. [3958] Drugs with predominant dopaminergic blockade such as amisulpride and aripiprazole are not associated with induction of OCS. For clozapine, anti-serotonergic profile combined with low anti-dopaminergic potency and enhanced glutamatergic transmission could explain OCS.…”

Section: Antipsychotic-induced Obsessive–compulsive Symptomsmentioning

confidence: 99%

Obsessive–compulsive disorder comorbid with schizophrenia and bipolar disorder

Sharma

Reddy

2019

Indian J Psychiatry

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Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Symptoms (OCS) are known to be highly comorbid with bipolar disorder and schizophrenia. Comorbid OCD/OCS influences the course of schizophrenia and bipolar disorder. There is also some evidence to suggest that a diagnosis of OCD may be associated with elevated risk for later development of psychosis and bipolar disorder. Comorbid OCD/OCS is associated with a greater severity of schizophrenia phenotype and poorer prognosis. In addition, certain atypical antipsychotics, clozapine in particular are known to induce or worsen OCS in schizophrenia. OCD when comorbid with bipolar disorder mostly runs an episodic course with worsening and improvement of OCD/OCS in depressive and in manic/hypomanic phases respectively. There is limited systematic data on the treatment of OCD in schizophrenia and bipolar disorder. When OCD presents in the context of schizophrenia, management may include treatment with atypical antipsychotics with limited serotonergic properties, changing the antipsychotic, reduction in the dose of the antipsychotic, addition of cognitive-behavior therapy (CBT), or a specific serotonin reuptake inhibitor (SSRI). When OCD is comorbid with bipolar disorder, mood stabilization is the priority. CBT may be preferred over SSRIs to treat OCD/OCS that persist in between the mood episodes because SSRIs may induce a switch or worsen the course of bipolar disorder. SSRIs when indicated have to be used judiciously under the cover of adequate mood stabilization.

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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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Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses

Cited by 32 publications

References 102 publications

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Obsessive–compulsive disorder comorbid with schizophrenia and bipolar disorder

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

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