The Paradox of Quetiapine in Obsessive-Compulsive Disorder

Abstract

Schizophrenia and obsessive-compulsive disorder (OCD) have historical, clinical, and epidemiological links. The clinical use of atypical neuroleptics (ie, dual serotonin-dopamine antagonists) to treat both conditions sheds a new light on them. We report the first two cases of obsessive-compulsive symptoms (OCS) induced by quetiapine in schizophrenia patients. A case of successful augmentation by quetiapine in refractory OCD is also presented. A review of the literature on OCS induced by atypical neuroleptics follows. This paradoxically induced OCD symptomology in schizophrenia patients administered atypical neuroleptics is discussed from new pathophysiological and clinical perspectives. The discussion emphasizes the prognostic implications of OCS in schizophrenia and available therapies for this comorbidity.

Open Label Aripiprazole in the Treatment of Youth with Tic Disorders

“…To date, the treatment of OCD with atypical antipsychoatics has resulted in equivocal findings. Quetiapine and olanzapine, for instance, have been found to both significantly ameliorate and worsen symptoms (Tranulis et al 2005;Gao et al 2006;Diniz et al 2009). However, the study of aripiprazole has offered preliminary support for its use in treating OCD (Szechtman et al 1999;Connor et al 2005;Murphy et al 2005;Schneier et al 2008;Storch et al 2008).…”

“…A recent animal model of marble burying suggest that aripiprazole's (Matsushita 2005) 5-HT 1A agonist effect is specific for OCD. Whereas atypicals with lower D 2 but higher 5-HT 2A antagonist properties may worsen OCD symptoms (Tranulis et al 2005;Gao et al 2006). Further study of the potential efficacy of aripiprazole in pediatric OCD patients who have not responded to first-line treatments is warranted.…”

Obsessive–Compulsive Disorder Comorbidity: Clinical Assessment and Therapeutic Implications

“…Conventional neuroleptics with high D 2 -blocking potency, such as haloperidol and pimozide, do not seem to worsen OCD while the lower potency conventional neuroleptic chlorpromazine induced OCS in two patients (Howland, 1996). Most reports of APP-induced OCS in schizophrenic patients are related to clozapine, risperidone, olanzapine, and quetiapine (Ghaemi et al, 1995; Baker et al, 1996; Khullar et al, 2001; Reznik et al, 2004; Tranulis et al, 2005). A possible explanation of this phenomenon could be the involvement of 5HT 2A receptors and the disruption of the interaction of serotonin and dopamine within the cortico-striato-thalamocortical loops (Kapur and Remington, 1996).…”

Hypochondriasis and obsessive-compulsive disorder in schizophrenic patients treated with clozapine vs other atypical antipsychotics

“…Between the AAPs, clozapine (CLZ) seems to be associated to the higher rates of OCS or OCD comorbidities. 2,21 Two main pharmacodynamic hypotheses may account for this observation. The first hypothesis is based on the fact that CLZ has lower D2-blocking and stronger 5-HT2A and 5-HT2C blocking effect than other AAPs.…”