Treatment of Hypochondriasis in Two Schizophrenia Patients Using Clozapine

Tundo, Antonio; Proietti, Luca; Filippis, Rocco de

doi:10.1155/2017/5064047

Cited by 2 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 59 cases where antidepressants were added without simultaneously changing the dose of clozapine or adding other medications to treat OCS, 29 patients (49.2%) improved [17, 19-21, 27, 29, 30, 32-34, 36, 39, 48, 53, 60, 64, 65, 70, 72], whereas 30 patients (50.8%) demonstrated inadequate response to an initial trial of SSRI/ clomipramine [20,22,25,35,37,42,43,45,46,49,50,54,55,59,60,63,[66][67][68][69]71].…”

Section: Ssri or Clomipraminementioning

confidence: 99%

“…Twenty-five non-responders underwent additional trials to treat their OCS. Eleven non-responders underwent trials with different antidepressants [22,35,37,42,55,59,60,[67][68][69]71], of whom only 2 patients responded (18.2%) [37,67]. Sixteen (64.0%) non-responders showed improvement without psychotic exacerbation following a decrease in the dose of clozapine [42,45,46,49,55,59,60,66,68], of whom 8 (50.0%) were concomitantly treated with aripiprazole [49,55], 2 with antidepressants [59,66], 2 with both aripiprazole and antidepressant [42,45], and 1 with valproic acid [46].…”

Section: Ssri or Clomipraminementioning

confidence: 99%

“…In 16 cases, the reduction in the dose of clozapine coincided with the addition of: (1) aripiprazole (n = 9) [42,49,55], (2) an antidepressant (n = 2) [59,66], (3) valproate (n = 2) [46,51], (4) an antidepressant plus aripiprazole (n = 2) [42,45], and (5) amisulpride (n = 1) [50]. In 15 cases, the reduction in the dose of clozapine did not coincide with the addition of other medica- tions, which improved OCS in 14 cases [19,25,26,29,41,48,60,61,64,66,68]. For those that improved following a dose reduction, the mean clozapine dose at the time of OCS was 385.6 ± 183.6 mg/day and that following the dose reduction was 230.2 ± 129.8 mg/day (online suppl.…”

Section: Clozapine Dose Modificationmentioning

confidence: 99%

“…DOI: 10.1159/000505876 done) [44,50,51,53,59,66,68], OCS improved in 1 case using amisulpride while simultaneously reducing the dose of clozapine [50] and in another case using ziprasidone without simultaneous clozapine dose modification [44]. Of the 18 cases that added aripiprazole (i.e., a partial D 2 receptor agonist) [42,45,49,55,58,67,68], OCS improved in 11 cases while simultaneously reducing the dose of clozapine [42,45,49,55] and in another 5 cases without simultaneous clozapine dose modification [55,58]. Adding aripiprazole without reducing the dose of clozapine was associated with a higher rate of response (n = 5/7; 71.4%) than adding a D 2 antagonist without changing the dose of clozapine (n = 1/6; 16.7%) but did not reach significance (Fisher, p = 0.103).…”

Section: Antipsychotic Polypharmacymentioning

confidence: 99%

“…Other Pharmacological or Nonpharmacological Treatments Of the 5 cases that utilized valproate [46,51,57,68], OCS improved in 2 cases while simultaneously reducing the dose of clozapine [46,51] and in another case, without simultaneous clozapine dose modification [57]. Nine cases utilized cognitive behavioral therapy (CBT) [49,67,68], 2 cases utilized behavioral therapy [38,46], and 1 case utilized distraction techniques in combination with sertraline [64]. Significant improvement in OCS was noted in 1 case that utilized behavioral therapy [38] and in the case that utilized distraction techniques in combination with sertraline [64].…”

Section: Switching To Other Antipsychoticsmentioning

confidence: 99%

See 4 more Smart Citations

Clozapine-Associated Obsessive-Compulsive Symptoms and Their Management: A Systematic Review and Analysis of 107 Reported Cases

Kim¹,

Barr²,

et al. 2020

Psychother Psychosom

View full text Add to dashboard Cite

Background: It is not uncommon to find obsessive-compulsive symptoms (OCS) in patients treated with clozapine. These symptoms are attributed to anti-serotonergic effects of clozapine. The objective of this study was to conduct a systematic review of reported cases of clozapine-associated OCS to better understand the nature and management of these symptoms. Methods: MEDLINE, Embase, and PsycIN-FO databases were searched with no publication year or language restrictions. Studies reporting cases of clozapine-associated OCS, either de novo or exacerbation of preexisting OCS, were included. The final search date was July 11, 2019. Results: Fifty-seven studies, involving 107 cases (75 de novo, 32 exacerbated OCS), were included. Clozapine triggered moderate-severe OCS at varying doses (100-900 mg/day) and treatment durations (median 6 months, interquartile range 2-24 months). Higher severity was significantly associated with preexisting OCS, poorer insight into OCS, and active psychosis at the time of OCS. Common strategies to treat clozapine-associated OCS included adding selective serotonin reuptake inhibitors, clomipramine, or aripiprazole, often accompanied by clozapine dose reduction. The rate of response to antidepressants was 49% (29/59), where younger age, shorter duration of underlying illness, shorter clozapine treatment duration, better insight into OCS, and presence of taboo thoughts were significantly associated with antidepressant response. Subsequent clozapine dose reduction was effective in many non-responders, where aripiprazole was simultaneously added in 50% (8/16). Conclusions: Clozapine can trigger severe OCS. Adding aripiprazole with/ without clozapine dose reduction may be a good alternative to antidepressants for managing clozapine-associated OCS. Clinicians should be more vigilant about these adverse effects and administer appropriate treatments.

show abstract