Management of Clozapine-Induced Obsessive–Compulsive Symptoms in a Man with Schizophrenia

Zink, Mathias; Knopf, Udo; Kuwilsky, A.

doi:10.1080/00048670601172806

Cited by 27 publications

(28 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, whenever used, SSRIs were found to be useful in management of de novo OCS/OCD. There are reports of spontaneous resolution (Lykouras et al, 2003) and beneficial effect of dose reduction (Rocha and Hara, 2006;Zink et al, 2006;Englisch et al, 2009) and selective serotonin reuptake inhibitors (SSRIs) (de Haan et al, 1999;Lykouras et al, 2003). These findings suggest that whenever a patient develops de novo OCS/OCD with clozapine, the first strategy could be a wait and watch policy or dose reduction, depending on the severity of primary psychotic illness.…”

Section: Discussionmentioning

confidence: 99%

“…(Lykouras et al, 2003), while others suggest reduction in symptoms with reduction in doses of clozapine (Rocha and Hara, 2006;Zink et al, 2006;Englisch et al, 2009). Studies have also reported beneficial effect of aripiprazole (Englisch et al, 2009) and selective serotonin reuptake inhibitors (SSRIs) (de Haan et al, 1999;Lykouras et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre

Grover

Hazari

Chakrabarti

2015

Asian Journal of Psychiatry

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre

Grover

Hazari

Chakrabarti

2015

Asian Journal of Psychiatry

View full text Add to dashboard Cite

“…8,9 Further indication for improvement of clozapine-induced OCS after a combination with aripiprazole had been gained in a placebo-controlled clozapine-aripiprazole combination approach. 10 In the respective trial, however, major differences between OCS in verum and placebo groups at baseline complicate the interpretation of the achieved results.…”

Section: Discussionmentioning

confidence: 99%

Clozapine-Induced Obsessive-Compulsive Syndromes Improve in Combination With Aripiprazole

Englisch¹,

Esslinger²,

Inta³

et al. 2009

Clinical Neuropharmacology

Self Cite

View full text Add to dashboard Cite

Patients with schizophrenia often experience comorbid obsessive-compulsive syndromes (OCSs). Within these patients, a significant subgroup developed secondary OCS during treatment with antiserotonergic, atypical antipsychotic agents such as clozapine. Although cognitive behavioral therapy and antiobsessive antidepressants brought up inconsistent results, in some cases, dose reductions of clozapine in combination approaches were able to alleviate OCS. One suggestive agent for antiobsessive add-on treatment is aripiprazole, a partial agonist at dopamine and serotonin receptors.Here, we summarize the courses of 7 patients (6 men; mean age, 37 years; mean duration of psychotic illness, 17 years). They had been treated with clozapine for 9 years. The distressing and treatment-resistant comorbidity with OCS emerged approximately 4 years after the start of clozapine therapy. During combined treatment with mean doses of 22.9 mg of aripiprazole for 9.7 weeks, we assessed a small yet statistically not significant improvement of the psychotic disorder, whereas a marked reduction of obsessions and significant improvements of compulsions could be observed. The mean total Yale Brown Obsessive Compulsive Rating Scale decreased from 18.7 to 12.4 (P = 0.003).These data support the findings of 2 previous case reports and point toward an antiobsessive potency of aripiprazole. The relevant disabling comorbidities of psychosis and OCS need further investigation with multimodal neurobiological approaches. The proposed strategy should be further evaluated in prospective controlled trials with severity of comorbid OCS as a primary end point.

show abstract

“…Interestingly, though, the partial dopamine agonist aripiprazole seems to be promising. This substance has shown favorable effects in cases of both treatment-resistant OCS [55,56] and, augmentatively, in clozapine-induced OCS [57,58] and has been associated with de novo OCS only in 2 patients, so far [10] . Without any doubt, these data are preliminary and need to be confirmed by further investigations; however, it seems likely that not only dopamine-blocking approaches but also differential dopaminergic activation might be beneficial in OCS.…”

Section: Recent Neurobiological Evidence In Favor Of An Antagonistic mentioning

confidence: 99%

Neurobiology Confirms Psychopathology

Zink

Englisch²,

Dreßing³

2008

Psychopathology

Self Cite

View full text Add to dashboard Cite

Background: Psychopathological concepts of the 19th and early 20th century postulated an antagonism between psychotic and obsessive-compulsive disorders, assuming obsessions and compulsions to have protective effects on psychotic disintegration. Although both disorders have been subject to intense multimodal research, their pathogeneses are yet to be fully understood. Methods: Here, we discuss recent neurobiological findings pointing towards opposite directions which are strongly reminiscent of the historical psychopathological antagonism. Results: Obsessive-compulsive syndromes (OCS) are efficiently treated with serotonergic substances, while on the other hand modern antipsychotic drugs exert antiserotonergic effects. Especially these atypical antipsychotic substances, however, were found to involve the risk of inducing second-onset OCS. Dopamine antagonists are potent antipsychotic substances, whereas the partial dopamine agonist aripiprazole has been associated with an antiobsessive potency. Within the glutamatergic system, reduced NMDA-dependent glutamatergic neurotransmission is discussed to be one major pathomechanism of psychotic disorders, whilst NMDA antagonists have proven to be effective in improving treatment-resistant OCS. While neurogenetic findings seem to separate the populations in heterogeneous samples, detailed neuroimaging studies suggest that both disorders affect similar neurocircuits in different manners. Conclusions: With regard to these findings, future research on schizo-obsessive syndromes will have to be multimodal, integrating psychopathology, neuropsychology, functional imaging, neurogenetics and psychopharmacology. Prospective trials involving these methods might be able to elucidate the dysbalances of neurotransmission and to locate the neuroanatomical and neuropsychological correlates. In particular, this might contribute to defining schizophrenic patients at risk for developing second-onset OCS and to evaluating new treatment strategies in patients suffering from both psychosis and OCS.

show abstract

Management of Clozapine-Induced Obsessive–Compulsive Symptoms in a Man with Schizophrenia

Cited by 27 publications

References 9 publications

Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre

Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre

Clozapine-Induced Obsessive-Compulsive Syndromes Improve in Combination With Aripiprazole

Neurobiology Confirms Psychopathology

Contact Info

Product

Resources

About