Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause for clinical concern

Abstract

The association between schizophrenia and obsessive-compulsive disorder (OCD) is complex. This study systematically examined a UK cohort of clozapine-treated individuals with schizophrenia/schizoaffective disorder. Fourteen of 59 cases (24%) scored positively on item H of the Mini-International Neuropsychiatric Interview (MINI) for OCD. The mean Yale- Brown Obsessive-Compulsive Scale (Y-BOCS) score in MINI-positive cases was 17.6 (SD+/-6.3). Sixty-four percent scored 16 or more on the Y-BOCS, representing clinically meaningful illness severity. Seven (50%) patients with OCD had previously received the diagnosis by their treating clinicians and were already receiving with selective serotonin re-uptake inhibitors (SSRIs) treatment. OCD cases scored significantly worse than their non-OCD counterparts on the Abnormal Involuntary Movement Scale (P=0.01) and the Simpson Angus Scale (SAS; P=0.01). There was also a non-significant trend toward higher ratings for OCD cases on the Clinical Global Impression-Schizophrenia scale (P=0.06). Comparing the OCD cases taking SSRI (n=7) with those not on SSRI (n=7), significant differences emerged on the SAS (P=0.03). Our results suggest that OCD is common among patients receiving clozapine for schizophrenic disorders and that the comorbidity is associated with greater motoric impairment. The role of medication in this condition remains unclear.

Obsessive compulsive symptoms in patients with Schizophrenia on Clozapine and with Obsessive Compulsive disorder: A comparison study

“…However, a significant minority who had documented preclozapine symptoms reported improvement in symptoms. Previous studies have highlighted differential impact of clozapine on OCS in schizophrenia [10,11]. The reported rate of 11% preclozapine OCS was relatively low when compared to other studies.…”

The neuropsychology of the schizo-obsessive subtype of schizophrenia: a new analysis

“…Nevertheless, it is important to acknowledge that our results refer to antipsychoticresistant cases that are receiving clozapine and they therefore cannot necessarily be generalized to all cases of schizophrenia. Additionally, an intriguing literature suggests that antipsychotics may actually induce obsessive symptoms in patients with schizophrenia (see reviews by Fineberg et al 2006 ;Mukhopadhaya et al 2009) and has been estimated to occur in as many as 46.4 % of those treated with clozapine (Anil et al 2002, Galvez-Buccolini et al 2004. If this were to be the case, then we might infer that the obsessions and compulsions in our cases were not representative of archetypal OCD.…”

“…The prevalence of OCD in the general population remains quite controversial ; however, it is certainly much lower (with estimates from 0.08 to 2.5 % ; e.g. Fireman et al 2001 ;Crino et al 2005) than the prevalence of OCD in schizophrenia, which has estimates ranging from 0.5 to 59.2 % both in firstepisode and in chronic schizophrenia (Bland et al 1987 ;Karno et al 1988 ;Berman et al 1995 ;Eisen et al 1997 ;Poyurovsky et al 1999aPoyurovsky et al , 2000Poyurovsky et al , 2003Poyurovsky et al , 2006Bermanzohn et al 2000 ;Kruger et al 2000 ;Niehaus et al 2005 ;Mukhopadhaya et al 2009) and for OCS in schizophrenia the estimated prevalence is similarly between 3.5 and 46 % (Rosen, 1957 ;Myers et al 1984 ;Fenton & McGlashan, 1986 ;Berman et al 1995Berman et al , 1998Lysaker et al 2000 ;Tibbo et al 2000 ;Fabisch et al 2001). It remains unclear if this reflects a true comorbidity, more severe illness or perhaps a unique diagnostic subcategory of schizophrenia.…”

“…Magnetic resonance imaging studies have identified significantly reduced volumes in the left hippocampus, frontal lobes (Aoyama et al 2000) and anterior horn of the lateral and third ventricle (Goldstein et al 1999) for schizophrenia patients with OCS when compared with their schizophrenia counterparts without OCS. Additionally, schizo-obsessive patients show more neurological signs (Sevincok et al 2004), motor symptoms including catatonia, loss of motor ability or hyperactive motor activity (Tibbo et al 2000) and extrapyramidal symptoms (Kruger et al 2000 ;Ohta et al 2003 ;Mukhopadhaya et al 2009) compared with schizophrenia subjects ; and more tics when compared with patients with OCD (Poyurovsky et al 2006). However, not all studies have found more neurological or motor symptoms in schizo-OCD compared with OCD (Poyurovsky et al 2007).…”

A 44-Year-Old Woman with Intrusive Thoughts

“…1,2 Comorbid OCD/ OCS with schizophrenia has been associated with significantly worse positive and negative symptoms 3 and significantly worse motor dysfunction 2 when compared with patients with schizophrenia without OCD/OCS. Although the exact relationship remains unclear, explanations for this commonly identified comorbidity include: 1) comorbid OCS and schizophrenia patients may represent a pathophysiological subgroup of patients with schizophrenia 4 ; 2) OCS and schizophrenia may share a common genetic predisposition 5 ; 3) OCS may be induced by treatment of schizophrenia with atypical antipsychotics 6 ; and 4) previously existing OCS may be exacerbated by treatment with atypical antipsychotics.…”