clozapine and Obsessive-Compulsive-Disorder

Comorbid disorders often occur in psychoses from the schizophrenia spectrum and are an additional burden for patients' quality of life, render treatment and rehabilitation prognosis more difficult and can also contribute to suicidal ideation. Specifically, obsessive-compulsive syndrome (OCS) and OC disorder (OCD) have been reported.. What is known about the epidemiology and pathogenesis and which conclusions can be drawn regarding the diagnostics and treatment?. This review evaluated current reports on comorbid OCS during different stages of psychotic disorders, starting with the at-risk mental state (ARMS) via the first manifestation and up to chronic courses. The focus was on pharmacological and psychotherapeutic consequences.. Patients with ARMS suffer much more often from OCS than the general population. The prevalence is even higher in patients with a first manifestation of psychosis. During the chronic courses ca. 30% of patients are affected by comorbid OCS and 12% fulfill the diagnostic criteria of a OCD. The pathogenesis can most likely be explained by a genetic disposition in the glutamatergic system, shared structural and functional abnormalities of cortical and subcortical structures, pharmacological influences and psychosocial stressors.. Clozapine and other antipsychotics may induce or aggravate OCS in a dose-dependent manner. In order to alleviate symptoms clozapine should be reduced to a minimally sufficient level. This can be attempted through combination, for example with dopaminergic antipsychotics. In general, serotonergic antidepressants can be added. Cognitive behavioral therapy should be offered to every patient with comorbid OCS. For future research multimodal longitudinal studies investigating the efficacy of interventions and aimed at the subjective level will be important.. HINTERGRUND: Komorbide Störungen treten bei Psychosen aus dem schizophrenen Formenkreis häufig auf und belasten die PatientInnen zusätzlich in der Lebensqualität, erschweren Therapie und Rehabilitationsprognose und können auch zur Suizidalität beitragen. Dazu gehört das Auftreten obsessiv-kompulsiver Syndrome (OCS) bzw. einer Zwangsstörung (OCD).. Was ist bekannt über Epidemiologie und Pathogenese, welche Konsequenzen ergeben sich für Diagnostik und Therapie?. Die Literatur wurde in Hinblick auf OCS bei psychotischen Störungen, beginnend im „at risk mental state“ (ARMS) über die Erstmanifestation bis zum chronischen Verlauf evaluiert. Besondere Schwerpunkte lagen auf pharmakologischen und psychotherapeutischen Konsequenzen.. Obsessiv-kompulsive Syndrome treten beginnend mit dem ARMS deutlich häufiger auf als in der Allgemeinbevölkerung. Die Prävalenz ist bei Erstmanifestation noch höher und im chronischen Verlauf sind ca. 30 % der PatientInnen betroffen. Die Diagnose einer komorbiden OCD wird im chronischen Verlauf bei 12 % der PatientInnen gestellt. In der Pathogenese müssen genetische Disposition im glutamatergen System, gemeinsame kortikale und subkortikale Strukturen und Funktionen, pharmakologische Einflüsse und psychosoziale Stressoren bedacht werden.. Wenn eine Induktion oder Verstärkung der OCS durch Antipsychotika wie Clozapin vorliegt, sollte als kausale Therapie eine Clozapin-Dosisreduktion angestrebt werden. Dies kann durch Kombination z. B. mit dopaminergen Antipsychotika versucht werden. Allgemein können serotonerge Antidepressiva augmentiert werden. In jedem Fall komorbider OCS bei Psychose soll kognitive Verhaltenstherapie angewandt werden. Für die Forschung werden Studien sinnvoll sein, die an der subjektiven Ebene ansetzen und engmaschig longitudinal Verläufe und Therapieeffekte darstellen.

Topics: Antipsychotic Agents; Clozapine; Comorbidity; Humans; Obsessive-Compulsive Disorder; Psychotic Disorders; Quality of Life

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.. MEDLINE, Embase, and PsycINFO 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.. 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 cloza-pine 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).. 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.

Topics: Antidepressive Agents; Antipsychotic Agents; Aripiprazole; Clozapine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

This review will aim to summarize the current body of epidemiological, clinical and therapeutic knowledge concerning specific co-occurrence of obsessive-compulsive symptoms (OCSs) and schizophrenia spectrum disorder.. Almost 30% of the patients with schizophrenia display OCS, and three main contexts of emergence are identified: prodromal symptoms of schizophrenia, co-occurrence of OCS and schizophrenia and antipsychotics-induced OCS. Recent clinical studies show that patients with SZ and OCS have more severe psychotic and depressive symptoms, higher suicidality and lower social functioning. A recent cognitive investigation found that OCS and delusions share specific metacognitive profiles, particularly through a heightened need to control thoughts. Finally, a recent cross-sectional study of clozapine-induced OCS found a dose-response relationship between clozapine and OCS. OCS appeared reliably as linked to poorer outcomes among patients with schizophrenia. However, the specific clinical value of OCS among other prodromal symptoms of schizophrenia remains unknown.

Topics: Antipsychotic Agents; Clozapine; Cross-Sectional Studies; Humans; Obsessive-Compulsive Disorder; Prodromal Symptoms; Schizophrenia

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.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Dibenzothiazepines; Humans; Male; Obsessive-Compulsive Disorder; Olanzapine; Quetiapine Fumarate; Schizophrenia

Treatment-emergent obsessive-compulsive symptoms (OCSs) have raised concern since the widespread introduction of serotonin-dopamine antagonists (SDAs) for the treatment of schizophrenia. Further investigations of SDA-emergent OCSs and their response to anti-obsessional agents will be beneficial for clinicians in helping patients who suffer from this problem. We present three cases of schizophrenia in which distressing OCSs occurred during clozapine or risperidone treatment. OCSs were assessed consecutively using the Yale-Brown Obsessive-Compulsive Scale. The OCSs of these three patients were responsive to anti-obsessional agents, including fluvoxamine, clomipramine, and paroxetine. We also review the current literature and discuss the possible pathophysiology and psychopathology of SDA-emergent OCSs.

Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Risperidone; Schizophrenia; Treatment Outcome

A preponderance of patients with obsessive-compulsive disorder (OCD) experience little or no improvement in their symptoms when treated with serotonin reuptake inhibitors (SRIs). It is hypothesized that SRI-refractory patients may have altered serotonin neurotransmission different from patients responsive to SRIs, or that they may have abnormalities in their dopamine function. When drugs affecting serotonin function (e.g., tryptophan, fenfluramine, lithium, buspirone) are added to SRI therapy in SRI-refractory patients, results are mixed and not consistently encouraging. However, when drugs affecting dopamine function (e.g., pimozide, haloperidol, risperidone) are added to SRI therapy in SRI-refractory OCD patients, individuals with either a personal history or family history of tics experience a reduction in their symptoms.

Topics: Clinical Trials as Topic; Clozapine; Dopamine Agents; Drug Therapy, Combination; Female; Fenfluramine; Haloperidol; Humans; Lithium; Middle Aged; Obsessive-Compulsive Disorder; Selective Serotonin Reuptake Inhibitors; Serotonin Agents; Treatment Outcome; Tryptophan

The increasing recognition of Tourette's syndrome is probably responsible for the broadening range of symptom severities seen in clinic patients. Greater clinical diversity also brings greater treatment challenges, particularly for children in whom the risks and benefits of medication for the developing central nervous system must be weighed against the long-term risks associated with the disorder itself. Knowledge of the natural history and pathophysiology of Tourette's syndrome is vitally important for informed clinical decision making.. A MEDLINE literature search was undertaken to identify studies of the natural history and pathophysiology of Tourette's syndrome that would be relevant to clinical psychopharmacology.. Although impossible to predict with certainty for any given patient, the natural history of Tourette's syndrome is typically characterized by an early childhood onset, a prepubertal exacerbation, postpubertal attenuation, and an adult stabilization of symptoms. Symptoms fluctuate in all phases of the illness, often in response to stress. The natural history and clinical phenotype of Tourette's syndrome are thought to have both genetic and nongenetic determinants that are mediated through their effects on basal ganglia nuclei and related neural systems. Medications used in the treatment of Tourette's syndrome are thought to modulate the functioning of these neural systems.. Although medication decisions must consider tic symptom severity, expectations of the disorder's natural history, and the child's adaptive capacities-his or her comorbid illnesses, coping mechanisms, interpersonal relatedness, impulse control, affect regulation, and family and social supports-are the most important determinants of well-being and outcome. These therefore are the most important considerations when making treatment decisions, as well.

Topics: Adolescent; Adult; Age of Onset; Antipsychotic Agents; Child; Clozapine; Disease Progression; Diseases in Twins; Dopamine; Haloperidol; Humans; Obsessive-Compulsive Disorder; Phenotype; Pimozide; Risperidone; Tourette Syndrome; Treatment Outcome

To present a critical overview of the selected literature published in the past 7 years on the efficacy and safety of psychoactive agents in conduct disorder, schizophrenia, separation anxiety disorder, selective mutism, obsessive-compulsive disorder, panic disorder, major depressive disorder, bipolar disorder, and sleep and eating disorders.. Reports of double-blind and placebo-controlled trials and open studies were reviewed and selected studies presented.. Employment of larger samples of diagnostically homogeneous patients and a more sophisticated design and methodology led to progress in the treatment of most of these conditions. Data have been accumulated on dose range and safety of lithium in this age group, and there is supportive evidence that lithium is useful in reducing aggression.. For a rational treatment approach, further studies are needed, particularly in depression and conduct disorder; psychosocial-environment contributions and possible biological markers should be investigated in order to identify children who require psychopharmacological treatments and those who will respond to psychosocial interventions or the combination of both. Symptoms targeted to require pharmacotherapy and symptoms targeted to respond to psychosocial interventions have to be identified.

Topics: Adolescent; Alprazolam; Anticonvulsants; Antipsychotic Agents; Anxiety, Separation; Bipolar Disorder; Carbamazepine; Child; Child Behavior Disorders; Child, Preschool; Clonidine; Clozapine; Depressive Disorder; Dose-Response Relationship, Drug; Feeding and Eating Disorders; Fluoxetine; Humans; Imipramine; Lithium; Mutism; Obsessive-Compulsive Disorder; Phenobarbital; Phenytoin; Phobic Disorders; Schizophrenia; Sleep Wake Disorders; Tranquilizing Agents

Serotonin uptake inhibitors (SUIs) have been established as the first-line pharmacotherapy of obsessive compulsive disorder (OCD). However, approximately one half of patients who receive an adequate trial with these agents remain clinically unchanged. The addition of drugs that enhance serotonin (5-HT) neurotransmission, such as lithium and buspirone, to ongoing treatment in SUI-refractory patients has generally proved to be an ineffective strategy. The addition of dopamine antagonists to the regimens of SUI-resistant patients appears to be a useful approach for OCD patients with a comorbid chronic tic disorder (e.g., Tourette's syndrome) and possibly for those with concurrent psychotic spectrum disorders. These drug response data suggest that both the 5-HT and dopamine systems may be involved in the treatment, and possibly the pathophysiology, of specific subtypes of OCD.

Topics: Adult; Antipsychotic Agents; Clinical Trials as Topic; Clomipramine; Clozapine; Dopamine Antagonists; Drug Therapy, Combination; Female; Fluvoxamine; Haloperidol; Humans; Isoxazoles; Male; Obsessive-Compulsive Disorder; Piperidines; Risperidone; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Tic Disorders; Tourette Syndrome

The authors assessed the efficacy of clozapine monotherapy for adults with treatment-resistant obsessive-compulsive disorder.. Twelve adults with refractory obsessive-compulsive disorder participated in a 10-week, open-label, systematic trial of clozapine. They were assessed with the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, and the global improvement item of the Clinical Global Impression (CGI) scale.. None of the 10 patients who completed the trial was a responder. No significant change was observed in obsessive-compulsive or depressive symptoms or in scores on the CGI global improvement item.. These findings suggest that clozapine monotherapy is not effective for most adult patients with treatment-resistant obsessive-compulsive disorder.

Topics: Adult; Clozapine; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Treatment Outcome

Obsessive-compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms.. We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice. We used statistical mixed linear model techniques to evaluate the longitudinal influence of OCS severity on wellbeing and general functioning.. A total of 184 patients were included, with 527 face-to-face assessments and 64.7% evaluated three or more times. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Obsessional thinking and hoarding behaviour, but not compulsions, were significantly associated with the impact on wellbeing, which may be attributable to the ego-syntonic nature of the compulsions.. Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine.

Topics: Antipsychotic Agents; Clozapine; Comorbidity; Humans; Longitudinal Studies; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Quality of Life; Schizophrenia

The aim of this study was to evaluate brain connectivity by diffusion tensor imaging (DTI) in schizophrenia patients with clozapine-induced obsessive compulsive symptoms (OCS).. Eighteen schizophrenia patients, nine of which had clozapine-induced OCS (Clz-OCS (+)), 9 without OCS (Clz-OCS (-)) and 9 healthy controls were included. Psychopathology was evaluated with Positive and Negative Syndrome Scale and Yale-Brown Obsession and Compulsion Scale in the patient groups. All groups were assesed with neurocognitive tests and DTI.. Tract-Based Spatial Statistics based comparison of DTI revealed lower fractional anisotropy in the genu of corpus callosum (CC), right cingulum, left frontal white matter (WM) in the Clz-OCS (+) group, compared to controls. Fractional anisotropy was found to be lower in the bilateral occipital WM and higher in the bilateral medial temporal regions, anterior limb of internal capsule, cingulum, frontoparietal peripheral WM, right external capsule and genu of CC in Clz-OCS (+) patients compared to Clz-OCS (-).. WM integrity in several pathways such as cortico-striato-thalamo-cortical circuitry and orbito-frontal tracts seems to be affected differently in patients with Clz-OCS (+). Different neuroplastic effects of clozapine leading to occurrence of OCS in a subgroup of patients is possible, and needs further evaluation by longitudinal follow-up studies.

Topics: Brain; Clozapine; Diffusion Tensor Imaging; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Obsessive-compulsive symptoms induced by clozapine negatively affect treatment compliance. In some studies, clonazepam was shown to be beneficial in obsessive-compulsive disorder. However, in literature there are case reports of life-threatening complications associated with the combined use of clozapine and benzodiazepines. In this article, the efficacy and safety of the clonazepam augmentation were discussed in two patients who had obsessive-compulsive symptoms induced by clozapine. No life-threatening complications were detected during the follow-up period of more than two years, and the patients benefited dramatically from the addition of clonazepam. In treatment-resistant patients, clonazepam can be used with close monitoring for obsessivecompulsive symptoms associated with atypical antipsychotics. Keywords: Atypical antipsychotics, clonazepam, clozapine, obsessivecompulsive symptoms.

Topics: Antipsychotic Agents; Benzodiazepines; Clonazepam; Clozapine; Humans; Obsessive-Compulsive Disorder

The aim of this study was to investigate the clinical risk factors, phenomenology and the impact of clozapine induced obsessive-compulsive symptoms (OCS) in patients with schizophrenia. One hundred twenty-two patients receiving clozapine treatment for at least 6 weeks were assessed with Structured Clinical Interview for Axis-I Disorders for DSM-IV, Positive and Negative Syndrome Scale, Yale-Brown Obsessive Compulsive Scale and Checklist, Calgary Depression Scale, Clinical Global Impression Scale and WHO-Disability Assessment Schedule-II. Information about past and current clinical status were gathered through clinical interviews and medical records. With clozapine 44.3% of the patients had de novo OCS, 33.6% had OCS both before and after clozapine, 21.3% didn't report any OCS. Clozapine doses, clozapine and norclozapine plasma levels were not significantly different. Severity of OCS was affected by clozapine and norclozapine plasma levels, and correlated with increased disability. Obsessions were less in clozapine induced OCS group, and compulsions, especially of checking subtypes, were predominant, compared to the group with prior history of OCS, who reported a significant increase in checking compulsion after clozapine treatment. Clozapine induced OCS should be considered during cost/benefit assessment of clozapine treatment, and understanding the risk factors and its different phenomenology may shed light into the underlying mechanisms.

Topics: Adolescent; Adult; Aged; Clozapine; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Risk Factors; Schizophrenia; Young Adult

This case report describes successful maintenance treatment with oral S-ketamine in a patient with severe depression, who previously was resistant to electroconvulsive therapy and deep brain stimulation, and who also had comorbid psychotic and obsessive compulsive symptoms.

Topics: Administration, Oral; Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Clozapine; Deep Brain Stimulation; Depressive Disorder, Treatment-Resistant; Electroconvulsive Therapy; Female; Glycopyrrolate; Hallucinations; Humans; Ketamine; Middle Aged; Muscarinic Antagonists; Nitrazepam; Obsessive-Compulsive Disorder; Treatment Failure; Venlafaxine Hydrochloride

Evidence supports the fact that clozapine can induce stressful obsessive-compulsive symptoms (OCS). Although clozapine's robust inhibition of serotonergic neurotransmission is believed to be a key mechanism underlying clozapine-induced OCS, the exact mechanism(s) are not fully understood. Intuitively, it is reasonable to believe that the dose of clozapine is likely related to emergent OCS severity. However, there is conflicting evidence where both positive and inverse relationships have been demonstrated between clozapine dose and emergent OCS severity. Upon examination of clozapine's receptor profile, in particular its affinity for 5-HT

Topics: Antipsychotic Agents; Clozapine; Humans; Inhibition, Psychological; Obsessive-Compulsive Disorder; Schizophrenia

Clozapine is thought to induce obsessive compulsive symptoms (OCS) in schizophrenic patients. However, because OCS are often comorbid with schizophrenia regardless of clozapine treatment, it remains unclear whether clozapine can generate OCS de novo. Thus, it has been difficult to establish a causal link between clozapine and OCS in human studies. To address this question, we asked whether chronic treatment with clozapine can induce obsessive compulsive disorder (OCD)-like behavior in mice. We injected mice with long-term continuous release pellets embedded with clozapine four times at 60-day intervals and then monitored the mice for signs of OCD-like behavior up to 40 wk. of age. We found clozapine increases grooming behavior as early as 30 wk. of age. We also investigated the effect clozapine on grooming behavior in Sapap3 knockout (KO) mice, which are a well-known animal model of OCD. In Sapap3 heterozygous KO mice, clozapine increases grooming behavior much earlier than in wild-type mice, suggesting a clozapine-OCD gene interaction. Fluoxetine, which is often used in the treatment of OCS and OCD, reduced the grooming behavior induced by clozapine. These data demonstrate that chronic clozapine treatment can generate OCD-like behavior in mice and support the hypothesis that clozapine produces de novo OCS regardless of schizophrenia status.

Topics: Animals; Behavior, Animal; Clozapine; Grooming; Mice; Mice, Knockout; Nerve Tissue Proteins; Obsessive-Compulsive Disorder

As many as 30% of individuals with a schizophrenia spectrum disorder experience obsessive-compulsive symptoms (OCS). Clozapine has demonstrated superior efficacy for the treatment of medication-resistant schizophrenia but it is also associated with an increased risk for OCS. Because pharmacologic management of clozapine-related OCS can be particularly challenging, cognitive behavioral therapy (CBT) should be considered. Nevertheless, there are few detailed accounts of CBT for OCS and schizophrenia.. The authors describe the interdisciplinary outpatient care of a client who had a 25-year history of schizoaffective disorder, bipolar type, and OCS. The case formulation was used to guide interventions to target core schemas of being dangerous and defective. The case study describes the cognitive behavioral formulation, treatment targets, treatment course, and functional and symptom response.. The client received 21 sessions of a formulation-based CBT for psychosis protocol, which included a 6-session course of exposure with response prevention, consisting of imaginal and in vivo exposure to multiple salient harm stimuli. Reduced ratings of distress and a 50% reduction in OCS suggest that habituation and inhibitory learning occurred. The treatment of OCS resulted in the complete resolution of thought broadcasting. Subsequently, the client was more successful in his efforts to adhere to an action schedule.. The use of both the treatment approach described in this clinical case report and contemporaneous medication management preclude comment on the mechanism(s) of the therapeutic change observed in this case.. This report presents a means of conceptualizing the interplay between thought broadcasting and harm obsessions and discusses considerations in identifying and treating individuals with similar comorbid conditions, particularly in the context of clozapine treatment for medication-resistant psychosis.

Topics: Aged, 80 and over; Antipsychotic Agents; Bipolar and Related Disorders; Clozapine; Cognition; Concept Formation; Female; Humans; Male; Middle Aged; Obsessive Behavior; Obsessive-Compulsive Disorder; Psychotic Disorders; Schizophrenia; Young Adult

Topics: Adult; Antipsychotic Agents; Aripiprazole; Clozapine; Drug Therapy, Combination; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

A large proportion of schizophrenia patients treated with second generation antipsychotics will develop Obsessive Compulsive Disorder (OCD). However, there are few studies about the impact of this comorbidity and who is at higher risk. In this study of clozapine-treated patients, we aimed to determine the impact on outcome of clozapine-induced OCD, as well as the clinical and sociodemographic risk factors related to OCD-onset in clozapine patients. We had strict and novel inclusion criteria to minimise mis-identification of cases. The Obsessive-Compulsive Inventory-Revised (OCI-R) was used to divide 231 clozapine-treated patients into extreme cases of OCD (OCI  ≥ 24 or checking subscale ≥6) versus non-OCD (OCI <15 and checking subscale <4). The Global Assessment of Functioning (GAF), short version of Warwick-Edinburgh Wellbeing scale and Clinical Global Impression for schizophrenia (CGI) scales were used to determine outcome. Socio-demographic information was used to identify the risk factors for OCD development. We found that schizophrenia patients with OCD symptoms had a significantly lower patient rated wellbeing scores (p < 0.001) only (no difference in clinician rated wellbeing scores), higher CGI positive (p < 0.01) and higher CGI depressive scores (p < 0.05). The only risk factors that reached significance level were higher treatment dose (p < 0.01) and younger paternal age at birth (p < 0.05). There is scope for future studies based on e.g. imaging and genetic studies to further investigate causality, and in improving clinician screening for OCD.

Topics: Adult; Aged; Antipsychotic Agents; Clozapine; Cohort Studies; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Risk Factors; Schizophrenia

Topics: Antipsychotic Agents; Clozapine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Schizophrenia, Paranoid

Obsessive-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.. The 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.. OCD 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.. Screening 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.

Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Polypharmacy; Prevalence; Risk Factors; Schizophrenia; United Kingdom

Topics: Adult; Antipsychotic Agents; Clozapine; Female; Humans; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Risperidone; Tardive Dyskinesia; Time Factors; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Case-Control Studies; Chronic Disease; Clozapine; Cross-Sectional Studies; Female; Hospitals, Psychiatric; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

To study the prevalence, phenomenology and course of OCS/OCD in patients receiving clozapine.. Case records of 220 patients who received clozapine for at least 3 months were reviewed.. One fifth (N=42; 19.1%) of patients had OCS/OCD, of which majority (13.2%) had onset of OCS/OCD prior to starting of clozapine and remaining 5.9% developed OCS/OCD after starting of clozapine. About one fourth of the patients with pre-existing OCS/OCD had worsening with clozapine while the remaining maintained at the same level (55.17%) or improved (20.7%). Majority of the patients who developed de novo OCS/OCD on clozapine were females and OCS/OCD emerged within 12 months (69.2%) of starting of clozapine. In those who developed OCS/OCD with clozapine, among obsessions, pathological doubts were most common, followed by obsessions with sexual content; among compulsions repetitive checking was the most common. SSRIs were required for management in half the patients, while the remaining improved spontaneously or with reduction in clozapine dose.. Clozapine can lead to aggravation or de novo presentation of OCS/OCD but these can be managed with reduction in dose or addition of SSRIs.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Clozapine; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Retrospective Studies; Schizophrenia; Tertiary Care Centers; Young Adult

Topics: Adult; Antipsychotic Agents; Clozapine; Cross-Sectional Studies; Drug Therapy, Combination; Female; Humans; Lamotrigine; Male; Obsessive-Compulsive Disorder; Prevalence; Psychiatric Status Rating Scales; Psychotic Disorders; Risk; Schizophrenia; Triazines

Topics: Clozapine; Drug Administration Schedule; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Serotonin Syndrome; Sertraline; Treatment Outcome

Patients with schizophrenia have an increased lifetime risk of comorbid obsessive-compulsive symptoms. Up to 30% of these patients experience such symptoms and 12% may be diagnosed with obsessive-compulsive disorder. The presence of these symptoms in schizophrenia seems to be associated with poor outcomes including a greater suicidal risk. A subgroup of patients develops this symptomatology after the initiation with Second Generation Antipsychotics (SGA). Also, there is evidence of a causal relationship for this association, particularly for clozapine. The primary aim of this study was to investigate the association of this comorbidity with suicidality in a population of clozapine-medicated schizophrenic and schizoaffective patients (N=65). The prevalence of obsessive-compulsive symptoms in our sample was 29.2% (N=19) and the prevalence of obsessive-compulsive disorder was 13.8% (N=9). Significant positive correlations between suicidality and total Y-BOCS score and between Y- BOCS score and depressive symptoms were found. Further analysis indicated that a Y-BOCS score greater or equal than 8 was an independent predictor of suicide attempt during clozapine treatment. Routine screening for this adverse event should be warranted for this population.

Topics: Adult; Antipsychotic Agents; Clozapine; Comorbidity; Cross-Sectional Studies; Female; Humans; Male; Obsessive-Compulsive Disorder; Prevalence; Retrospective Studies; Schizophrenia; Suicidal Ideation; Suicide Prevention; Suicide, Attempted; Treatment Outcome; Young Adult

Obsessive-compulsive disorder (OCD) has been observed in a substantial proportion of patients with schizophrenia. Although cognitive-behavioural therapy (CBT) is well documented for OCD, few case studies are available regarding CBT for comorbid OCD in schizophrenia.. The study aims to present a case study to augment the limited knowledge concerning CBT treatment for OCD in patients with schizophrenia.. The research adopted a case study approach, with a baseline condition and repeated assessments during the 3-week treatment and 6-month follow-up period.. The treatment was successful and the patient achieved clinical significant change in OCD symptoms. The patient had a reduction on the Y-BOCS from 24 to 5 (79%) and from 38 to 10 (73%) on the OCI-R from before treatment to 6 months follow-up. He did not fulfil the criteria for an OCD diagnosis at the end of the 3-week treatment period, or the follow-up at 3- and 6 months.. The results strengthen the impressions given by previous case studies suggesting that CBT may be a promising treatment for OCD in patients with schizophrenia.

Topics: Adult; Clozapine; Combined Modality Therapy; Comorbidity; Follow-Up Studies; Humans; Implosive Therapy; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Psychometrics; Psychotherapeutic Processes; Quality of Life; Schizophrenia, Paranoid; Self Care

The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs.. We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs.. Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1-3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047).. Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.

Topics: Adult; Amisulpride; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Comorbidity; Female; Humans; Hypochondriasis; Male; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Paliperidone Palmitate; Prevalence; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Sulpiride

Obsessive compulsive symptoms are commonly reported in those with schizophrenia. Clozapine has previously been reported to induce, aggravate and alleviate these symptoms. It is unclear if these are similar to the symptoms experienced by those with obsessive compulsive disorder. This study describes the obsessive compulsive symptom profile of a population of patients with schizophrenia treated with clozapine (n = 62) and compares this with patients with Obsessive Compulsive Disorder (n = 35). All participants were attending an outpatient community mental health service. The Obsessive Compulsive Inventory (which measures the frequency and associated distress of a range of "behavioural" and "cognitive" symptoms), the Hospital Anxiety and Depression Scale and a demographic questionnaire were completed. In addition the schizophrenia group treated with clozapine completed the Brief Psychiatric Rating Scale. The OCD group reported significantly more symptoms for all OCI subscales compared to the clozapine group. Overall fourteen (22%) of the schizophrenia treated with clozapine group had clinically significant total OCI scores. Two (3%) had documented OCS pre clozapine. De novo OCS was reported in twelve (19%) cases. Nine (11%) had documented OC symptoms pre-clozapine while only two (3%) had symptoms after clozapine was initiated. In terms of OC symptom profile, the clozapine group scored highest on the Doubting scale, a cognitive symptom whereas the OCD group scored highest on Washing, a behavioural symptom. Both groups reported greater distress with cognitive rather than behavioural symptoms. Medication including clozapine dose was not correlated with symptom severity. Anxiety correlated highly with obsessive compulsive symptoms in the Clozapine group but not the OCD group. Within the Clozapine group, Obsessing correlated highly with Unusual Thought Content. Findings suggest that obsessive compulsive symptoms in the Clozapine group may reflect a subtype of 'schizo-obsessive' disorder.

Topics: Adult; Antipsychotic Agents; Clozapine; Compulsive Behavior; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Obsessive Behavior; Obsessive-Compulsive Disorder; Schizophrenia; Severity of Illness Index

Among antiserotonergic second generation antipsychotics (SGA), particularly treatment with clozapine (CLZ) is associated with the development of second-onset obsessive compulsive symptoms (OCS) in schizophrenia. However, less is known regarding the factors that increase the individual susceptibility for the development of SGA-associated second-onset OCS in schizophrenia. Here we present the case of a 29-year-old female patient with disorganized schizophrenia who exhibited OCS due to fluvoxamine-induced elevation of CLZ serum levels via inhibition of CYP 1A2 und 2C19. The severity of the observed OCS featured an association with CLZ serum levels. The case illustrates the interaction between fluvoxamine add-on and CLZ serum levels on the development of OCS in schizophrenia and emphasizes the need of regular therapeutic drug monitoring.

Topics: Adult; Antipsychotic Agents; Clozapine; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Clinical observations indicate that atypical antipsychotics, especially clozapine, induce obsessive-compulsive (OC) symptoms in schizophrenia patients. Recent data from neuroimaging and clinical trials suggest a role for altered glutamate neurotransmission in the etiology of OC disorder (OCD), and SLC1A1, GRIN2B, and GRIK2 have all been reported to regulate glutamate transmission and affect OCD pathophysiology.. This study aimed to determine whether SLC1A1, GRIN2B, and GRIK2 are associated with clozapine-induced OC symptoms.. A total of 250 clinically stable schizophrenia patients receiving clozapine treatment were recruited. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to evaluate the severity of OC symptoms. Based on their Y-BOCS scores, 250 patients were divided into the OC and non-OC groups (patients with or without OC symptoms, respectively). Additionally, three reported OCD susceptibility polymorphisms, SLC1A1 (rs2228622), GRIN2B (rs890), and GRIK2 (rs1556995), were genotyped.. Trends of association with OC symptoms were observed in rs2228622A and rs890T alleles. SLC1A1 and GRIN2B interaction was found in the significant two-locus gene-gene interaction model (p = 0.0021), using the multifactor dimensionality reduction method. Further analysis showed a significant interaction between SLC1A1 and GRIN2B on the Y-BOCS score (F 6, 137 = 7.650, p < 0.001), and individuals with AA/TT genotypes had a significantly higher mean Y-BOCS score than those with other genotypes, except AG/TT.. These results suggest that SLC1A1, GRIN2B, and interactions between the two may potentially confer a susceptibility to OC symptoms in schizophrenia patients receiving clozapine.

Topics: Adult; Alleles; Antipsychotic Agents; Clozapine; Cross-Sectional Studies; Excitatory Amino Acid Transporter 3; Female; Genetic Predisposition to Disease; Genotype; GluK2 Kainate Receptor; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Polymorphism, Genetic; Psychiatric Status Rating Scales; Receptors, Kainic Acid; Receptors, N-Methyl-D-Aspartate; Schizophrenia; Severity of Illness Index

Topics: Clozapine; Genetic Association Studies; Humans; Obsessive-Compulsive Disorder; Pharmacogenetics; Polymorphism, Genetic; Schizophrenia

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Clozapine; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Resistance; Drug Substitution; Drug Therapy, Combination; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Quetiapine Fumarate; Recurrence; Sertraline

To compare the prevalence of obsessive-compulsive symptoms (OCS) in a population of patients with schizophrenia taking clozapine, olanzapine, or risperidone or taking no antipsychotic medication.. Baseline data of the Genetic Risk and Outcome of Psychosis study were collected between April 2005 and October 2008. We conducted a naturalistic cross-sectional study of 543 patients with schizophrenia and related disorders, who were recruited from multiple mental health centers, including inpatient and outpatient clinics, across The Netherlands. The patients met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and were taking no antipsychotic medication or taking clozapine, olanzapine, or risperidone. OCS severity was measured with the Yale-Brown Obsessive Compulsive Scale. We compared patients to a sample of 575 healthy controls.. Prevalence of OCS in patients was significantly higher than in the control sample, 23.4% versus 4.9% (χ(2) = 73.8, P < .001). Patients taking clozapine reported OCS significantly more often during the last week (38.9%), when compared to patients taking olanzapine (20.1%, χ(2) = 10.02, P = .002) or risperidone (23.2%, χ(2) = 5.96, P = .015) and patients taking no antipsychotics (19.6%, χ(2) = 8.20, P = .004). Patients taking clozapine for 6 months or longer reported OCS significantly more often than patients taking clozapine for less than 6 months, 47.3% versus 11.8% (χ(2) = 6.89, P = .009).. Treatment with clozapine in patients with schizophrenia is associated with a higher prevalence of OCS, especially when patients have been taking clozapine for 6 months or longer. We cannot rule out the possibility that this association is related to illness characteristics. Patients treated with risperidone or olanzapine or without treatment with antipsychotic medication had comparable prevalence of OCS, all significantly higher than the control sample.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Case-Control Studies; Causality; Clozapine; Cross-Sectional Studies; Female; Humans; Male; Netherlands; Obsessive-Compulsive Disorder; Olanzapine; Psychiatric Status Rating Scales; Risperidone; Schizophrenia; Young Adult

Topics: Adult; Antipsychotic Agents; Aryl Hydrocarbon Hydroxylases; Clomipramine; Clozapine; Comorbidity; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 CYP2C19; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Dose-Response Relationship, Drug; Drug Interactions; Drug Monitoring; Drug Therapy, Combination; Fluoxetine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Selective Serotonin Reuptake Inhibitors

There is evidence that combining selective serotonin reuptake inhibitor (SSRI) antidepressant and antipsychotic drugs may improve negative symptoms in schizophrenia and resistant symptoms in obsessive-compulsive and affective disorders. To examine the mechanism of action of this treatment we investigated the molecular modulation of γ-aminobutyric acid-A (GABA(A)) receptor components and biochemical pathways associated with GABA(A) receptor function following administration of the SSRI fluvoxamine (Flu) combined with the first-generation antipsychotic haloperidol (Hal) and compared it to the individual drugs and the atypical antipsychotic clozapine (Clz). We analysed prefrontal cortices of Sprague-Dawley rats injected intraperitoneally (i.p.) with the combination of Flu (10 mg/kg) and Hal (1 mg/kg), each drug alone, or Clz (10 mg/kg) after 30 min and 1 h. We found that haloperidol plus fluvoxamine (Hal-Flu) co-administration, and Clz, decreased the level of GABAAβ2/3 receptor subunit in the cytosolic fraction, and increased it in the membrane compartment in rat PFC. Flu or Hal alone did not produce changes in GABAAβ2/3 receptor protein expression. Additionally, Hal-Flu and Clz regulated molecular signalling pathways that modulate GABA(A) receptor function, including protein kinase C (PKC) and extracellular signal-regulated kinase-2 (ERK2). In primary cortical culture, short-term treatment (15 min) with Hal-Flu combination and Clz increased GABAAβ subunit phosphorylation levels. Pretreatment of the cells with PKC inhibitor abolished the effect of the combined treatment, or Clz on phosphorylation of GABA(A) receptor. Inhibition of ERK2 did not alter the effect of drugs on GABA(A) receptor phosphorylation levels. Our findings provide evidence that the combined treatment regulates GABA(A) receptor function and does so via a PKC-dependent pathway.

Topics: Animals; Antidepressive Agents; Antipsychotic Agents; Cells, Cultured; Clozapine; Dopamine; Drug Therapy, Combination; Fluvoxamine; Haloperidol; Male; Mitogen-Activated Protein Kinase 1; Mood Disorders; Obsessive-Compulsive Disorder; Phosphorylation; Prefrontal Cortex; Protein Kinase C; Rats; Rats, Sprague-Dawley; Receptors, GABA-A; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Denovo obsessive-compulsive (OC) symptoms are associated with the use of atypical antipsychotics, clozapine in particular. Treatment of clozapine-associated OC symptoms is challenging and often difficult because continuation of clozapine can result in worsening of OC symptoms, whereas discontinuation may result in worsening of psychosis. We report, for the first time, the use of maintenance electroconvulsive therapy, in clozapine-associated OC symptoms, in a patient with schizophrenia.

Topics: Adult; Antipsychotic Agents; Clozapine; Electroconvulsive Therapy; Female; Humans; Obsessive-Compulsive Disorder; Schizophrenia; Treatment Outcome

Epidemiological investigations show that up to 30% of schizophrenic patients suffer from obsessive-compulsive symptoms (OCS) associated with negative impact on the general prognosis. It has been proposed that antiserotonergic second-generation antipsychotics (SGAs) might induce OCS, but investigations of large samples integrating psychopathology, neuropsychology and psychopharmacology are missing.. We stratified 70 patients with schizophrenia according to their mode of antipsychotic treatment: clozapine and olanzapine (group I) compared with aripiprazole and amisulpride (group II). The groups were matched according to age, sex, educational levels and severity of the psychotic disorder (Positive and Negative Syndrome Scale). As the primary endpoint, we evaluated OCS severity (Yale-Brown Obsessive-Compulsive Scale).. OCS were significantly more prevalent and severe in group I, in which OCS severity correlated with dosage of clozapine and duration of treatment. Pronounced cognitive deficits in group I were found in visuospatial perception and visual memory (Wechsler Adult Intelligence Scale-Revised block design, Rey-Osterrieth Complex Figure Test), impulse inhibition (go/no-go test), higher perseveration scores (Wisconsin Card Sorting Test) and reduced set-shift abilities (Trail Making Test Part B, Set-shift Task). These cognitive domains correlated with OCS severity.. OCS in schizophrenia are associated with antiserotonergic SGA treatment, but longitudinal studies have to prove causality. Before starting treatment with antiserotonergic SGAs, specific neurocognitive domains should be evaluated, as visuospatial learning and impulse inhibition performance might allow early detection of OCS secondary to antipsychotic treatment in schizophrenia.

Topics: Adult; Amisulpride; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Comorbidity; Female; Germany; Humans; Male; Matched-Pair Analysis; Obsessive-Compulsive Disorder; Olanzapine; Piperazines; Prevalence; Quinolones; Schizophrenia; Serotonin Antagonists; Severity of Illness Index; Sulpiride

Topics: Adult; Antipsychotic Agents; Aripiprazole; Clozapine; Drug Therapy, Combination; Humans; Male; Obsessive-Compulsive Disorder; Piperazines; Quinolones

Obsessive-compulsive disorder (OCD) is a heterogenous disorder with different clinical presentations. The most common symptoms are those that involve contamination, possible harm, ordering/symmetry, aggressive/sexual/religious concerns and hoarding. A variety of less common symptoms have been described. Unusual OCD symptoms may lead to misdiagnosis, inappropriate treatment with possible serious side effects. In this report we present a case of an adolescent girl in which unusual OCD presentation and symptoms were misinterpreted to represent psychosis and exacerbation of OCD symptoms with risperidone and clozapine treatment. We discuss the possible pathophysiological mechanisms of OCD symptom exacerbation, clinical implications, and successful management of this case, with fluvoxamine therapy. This case may represent the first report of musical obsessions successfully managed with fluvoxamine therapy.

Topics: Adolescent; Antipsychotic Agents; Clozapine; Diagnostic Errors; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Psychotic Disorders; Risperidone

Topics: Antipsychotic Agents; Clozapine; Comorbidity; Cytochrome P-450 CYP1A2; Cytochrome P-450 CYP1A2 Inhibitors; Cytochrome P-450 CYP3A; Cytochrome P-450 CYP3A Inhibitors; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Risk Factors; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors

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.

Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Cross-Sectional Studies; Diazepam; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Muscarinic Antagonists; Obsessive-Compulsive Disorder; Psychotic Disorders; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; United Kingdom

Usher syndrome, the most common case of deaf - blindness, may be associated with various psychiatric disorders. Inability of communication through spoken language in association with progressive visual impairment affects diagnostics and management in case of co-morbidity with mental disorder. A patient with Usher syndrome and psychiatric symptoms is described and the difficulties in psychiatric assessment in her case are discussed. A 28 years old woman with hearing impairment diagnosed at the age of 3 months and progressive pigmentary retinopathy diagnosed at the age of 19 years, has been treated for ADHD in childhood, eating disorder in adolescence and psychosis-like disorder in adult life. Direct observation of patient behavior and the effects of pharmacotherapy were the main diagnostic procedures, since the use of sign language and handwriting was very limited. The limitations of management are discussed.

Topics: Adult; Anorexia Nervosa; Anti-Anxiety Agents; Antipsychotic Agents; Clozapine; Comorbidity; Diagnosis, Differential; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Humans; Mental Disorders; Obsessive-Compulsive Disorder; Pregabalin; Psychotic Disorders; Recurrence; Social Isolation; Usher Syndromes; Violence

Topics: Antipsychotic Agents; Aripiprazole; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Piperazines; Quinolones; Schizophrenia; Young Adult

Topics: Antidepressive Agents, Tricyclic; Clomipramine; Clozapine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adult; Antipsychotic Agents; Atrophy; Caudate Nucleus; Clonazepam; Clozapine; Dibenzothiazepines; Electromyography; Fluoxetine; Humans; Magnetic Resonance Imaging; Male; Mouth Protectors; Neuroacanthocytosis; Obsessive-Compulsive Disorder; Quetiapine Fumarate; Self-Injurious Behavior

Topics: Adult; Antipsychotic Agents; Clozapine; Comorbidity; Dose-Response Relationship, Drug; Humans; Male; Obsessive-Compulsive Disorder; Schizotypal Personality Disorder; Treatment Outcome

The selective serotonin (5-HT) reuptake inhibitors (SSRIs) represent the first-line pharmacotherapy for obsessive-compulsive disorder (OCD), and atypical antipsychotic drugs, which block 5-HT2A receptors, are used in augmentation strategies. Opiate drugs are also effective in treatment-refractory OCD and Tourette syndrome. The 5-HT2A-related behavior (i.e., head twitch) has been related with tics, stereotypes, and compulsive symptoms observed in Tourette syndrome and OCD.. The aim of this study was to explore whether 5-HT2A-related behavior is affected by atypical opiate drugs.. Head-twitch response was induced in mice by administration of either 5-hydroxytryptophan (5-HTP) or the 5-HT2A/C agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI). Dose-effect curves of atypical opiate drugs [(+/-)-tramadol, (-)-methadone and levorphanol], morphine, and other psychoactive drugs (fluvoxamine, desipramine, nefazodone, and clozapine) were performed. Opioid mechanisms were investigated by administration of naloxone.. All the opiates tested reduced both 5-HTP and DOI-induced behavior in a naloxone-reversible fashion, atypical opiates being more effective. The effects of the other drugs depended on the protocol, clozapine being the most effective.. Combined 5-HT and opioid properties result in a greater efficacy in antagonizing 5-HT2A-related behavior. These results provide behavioral evidence to support convergent effects of the 5-HT and opioid systems in discrete brain areas, offering the potential for therapeutic advances in the management of refractory stereotypes and compulsive behaviors.

Topics: 5-Hydroxytryptophan; Analgesics, Opioid; Animals; Clozapine; Desipramine; Disease Models, Animal; Dose-Response Relationship, Drug; Fluvoxamine; Indophenol; Levorphanol; Male; Methadone; Mice; Morphine; Naloxone; Narcotic Antagonists; Obsessive-Compulsive Disorder; Piperazines; Receptor, Serotonin, 5-HT2A; Receptor, Serotonin, 5-HT2C; Stereotyped Behavior; Tics; Tourette Syndrome; Tramadol; Triazoles

It has been reported that some schizophrenic patients suffer from obsessive-compulsive symptoms (OCS), and clozapine treatment is quite often associated with an occurrence/increase of OCS in schizophrenic patients. The aim of the study was to explore whether differences would exist in the clinical symptomatology and the whole blood serotonin (5-HT) concentrations in patients with obsessive-compulsive disorder (OCD), schizophrenic patients with and without OCS (S+OCS, S-OCS), and clozapine-treated schizophrenic patients with and without clozapine-induced OCS (CLZ+OCS, CLZ-OCS). We found that S+OCS patients (n=15) showed significantly lower scores on the Hamilton Anxiety Scale (HAMA), but similar levels of compulsions and obsessions using Yale-Brown Obsessive-Compulsive Scale (YBOCS) as compared to the patients (n=35) with OCD. S+OCS patients scored significantly lower on the Positive and Negative Syndrome Scale (PANSS) but higher on the Hamilton Depression Scale (HAMD) compared with S-OCS patients (n=19). However, CLZ+OCS patients (n=15) suffered from dominant compulsions but fewer obsessions compared with the OCD and S+OCS patients. OCD, S+OCS and CLZ+OCS groups had significantly lower levels of whole blood 5-HT than did the healthy volunteers (n=15), S-OCS and CLZ-OCS groups. It suggests that alterations in serotonin metabolism may be a common biological characteristic of OCS in OCD as well as in schizophrenia.

Topics: Adolescent; Adult; Antipsychotic Agents; Clozapine; Comorbidity; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Serotonin; Statistics as Topic

Topics: Adult; Anti-Anxiety Agents; Antipsychotic Agents; Aripiprazole; Clozapine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Male; Obsessive-Compulsive Disorder; Paroxetine; Piperazines; Psychiatric Status Rating Scales; Quinolones; Schizophrenia, Paranoid

Topics: Adult; Antimanic Agents; Antipsychotic Agents; Clozapine; Drug Therapy, Combination; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Valproic Acid

Clozapine-induced obsessive/compulsive symptoms (OCS) have been reported by many authors. This study investigated the incidence of these side effects, together with the relation between these side effects and the plasma concentration (Cps) of clozapine and its metabolites norclozapine and clozapine-N-oxide in schizophrenic patients. One hundred and two schizophrenic patients treated with clozapine were interviewed and screened with questionnaires testing for OCS during a 1-year study period. Cps of clozapine and the metabolites were monitored using reversed-phase high-performance liquid chromatography with ultraviolet detection. Thirty-nine patients (38.2%) presented with OCS, and, of these, 29 patients (28.4%) were classified as clozapine-induced, with an average latent period of 39.8+/-22.5 months. The Cps of clozapine and norclozapine were significantly higher in patients with OCS than in those without (595.1+/-364.9 vs. 433.5+/-252.8 ng/mL, P=0.001 and 266.4+/-144.4 vs. 203.1+/-119.8 ng/mL) OCS. Clozapine-induced OCS were not uncommon side effects. The authors suggest that the emergence of these side effects may be related to higher Cps of clozapine and clinicians should routinely check for and manage these side effects.

Topics: Adult; Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Drug Monitoring; Female; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

The aim of the present study was to assess the occurrence of obsessive-compulsive symptoms (OCS) in schizophrenic patients treated with clozapine, and to examine the relationship between OCS and other clinical variables. The results support earlier findings which suggest that clozapine produces or unmasks OCS. In addition, the severity of OCS was not related to other dimensions of psychopathology, severity of illness, clinical improvement or dose and duration of clozapine treatment.

Topics: Adult; Antipsychotic Agents; Clozapine; Female; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors

Obsessive-compulsive symptoms (OCSs) frequently occur in schizophrenia and seem to worsen prognosis. Many case studies suggest that OCSs appear or worsen with an atypical antipsychotic agent treatment (that is, with risperidone, olanzapine, and clozapine). Therefore, family or personal history of OCS should be investigated before initiating such treatment, and OCS onset should be monitored during treatment. Clozapine is involved in most such cases. When OCSs appear with clozapine, dosage can be reduced and a serotonin reuptake inhibitor treatment added. Current studies suggest that patients with schizophrenia and OCSs should benefit from treatment with an antipsychotic and an antiobsessive medication. Two controlled trials deal with OCS treatment in schizophrenia: the first, with clomipramine; and the second, with fluvoxamine. Both have proven their efficacy, but these trials include a small number of patients with heterogeneous characteristics.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Humans; Obsessive-Compulsive Disorder; Olanzapine; Risperidone; Schizophrenia; Severity of Illness Index

Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others.. The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology.. Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses.. Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis. OCD:Obsessive-compulsive disorder OCS:Obsessive-compulsive symptoms SRI:Serotonin reuptake inhibitors

Topics: Adult; Antipsychotic Agents; Clozapine; Cross-Sectional Studies; Female; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists; Sex Characteristics; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Clozapine; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Severity of Illness Index

Topics: Antipsychotic Agents; Clozapine; Humans; Obsessive-Compulsive Disorder

Topics: Adult; Antipsychotic Agents; Child; Child Abuse, Sexual; Clozapine; Humans; Male; Mental Recall; Motivation; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology; Self-Injurious Behavior; Treatment Outcome

Several lines of research suggest that prefrontal cortex dysfunctions observed in obsessive compulsive disorder (OCD) and schizophrenia (SKZ) are linked to two partially independent neuroanatomic systems: the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex, with different neuroanatomic connections, including the striatum. The primary aim of this study was to test this hypothesis using a double dissociation study of neuropsychological tasks performance of the dorsolateral prefrontal cortex and ventromedial prefrontal cortex.. We administered the Wisconsin Card Sorting Test, the Gambling Task, and the four-disk version of the Tower of Hanoi to 110 SKZ and 67 OCD patients and 56 control subjects.. A clear double dissociation of Wisconsin Card Sorting Test and Gambling Task performances was found, with SKZ patients performing the Wisconsin Card Sorting test significantly worse than OCD patients and control subjects and OCD patients performing the Gambling Task significantly worse than SKZ and control subjects. Both SKZ and OCD patients performed the Tower of Hanoi significantly worse than control subjects.. Results from our double dissociation study confirm the hypothesis of involvement of different frontal lobe subsystems within basal-corticofrontal circuits function in SKZ and OCD.

Topics: Adult; Antipsychotic Agents; Basal Ganglia; Case-Control Studies; Clozapine; Corpus Striatum; Dissociative Disorders; Female; Frontal Lobe; Haloperidol; Humans; Male; Neural Pathways; Neuropsychological Tests; Obsessive-Compulsive Disorder; Predictive Value of Tests; Prefrontal Cortex; Risperidone; Schizophrenia

Since a substantial proportion of schizophrenia patients has symptoms of obsessive-compulsive disorder (OCD), we sought to provide a phenomenological characterization of a schizophrenia subgroup with OCD.. A consecutive sample of patients who met DSM-IV criteria for both schizophrenia and OCD (N = 55) was compared with 55 schizophrenia patients without OCD matched for age and number of hospitalizations. Structured Clinical Interview for DSM-IV Axis I psychiatric disorders (SCID-I), including a specific module for tic disorders based on DSM-IV criteria, Scales for the Assessment of Positive and Negative Symptoms, Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impressions scale, and Hamilton Rating Scale for Depression were used.. Schizophrenia patients with OCD (N = 55) had lower positive dimension scores than schizophrenia patients without OCD (N = 55) (p =.01). Two subgroups of schizo-obsessive patients were identified: OCD independent of schizophrenia symptoms and OCD partially overlapping positive schizophrenia symptoms. Schizophrenia patients with OCD had more SCID-detectable OCD-spectrum disorder, primarily body dysmorphic disorder and chronic tic disorders. More schizophrenia patients with OCD were treated with either add-on serotonin reuptake inhibitors or clozapine.. Schizophrenia patients with OCD differ from their non-OCD-schizophrenia counterparts in severity of schizophrenia symptoms, co-occurrence of OCD-spectrum disorders, and pharmacotherapy. These findings and the identification of 2 subgroups of schizo-obsessive patients support the validity of this unique clinical entity and may facilitate the establishment of diagnostic criteria for a schizo-obsessive subtype of schizophrenia.

Topics: Adult; Clozapine; Comorbidity; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors; Serotonin Antagonists

Topics: Antipsychotic Agents; Behavior Therapy; Clozapine; Combined Modality Therapy; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Schizophrenia

To report on the possible development of serotonin syndrome in a patient receiving clomipramine after clozapine was withdrawn from the treatment regimen.. A 44-year-old white man with a 23-year history of undifferentiated schizophrenia and obsessive-compulsive behavior had been treated with clozapine and clomipramine for several years. He tolerated both agents together well, with the exception of experiencing chronic constipation. Clomipramine was tapered and reduced to 50 mg over a period of 10 days. A worsening of ritualistic behavior was noted, and the clomipramine dosage was increased to 150 mg/d over 14 days. Simultaneously with the clomipramine dosage increase, clozapine was tapered and stopped ever a period of 19 days. The day after clozapine was stopped, while he was still receiving clomipramine 150 mg/d, he began behaving oddly, started sweating profusely, shivering, and became tremulous, agitated, and confused. He was diagnosed with possible serotonin syndrome; his symptoms resolved after clomipramine was stopped but before clozapine was restarted eight days later.. There are similarities in symptoms between serotonin syndrome and clozapine withdrawal. This article discusses the reasons why this case may represent serotonin syndrome rather than clozapine withdrawal and the possible pharmacologic mechanisms involved.. Clinicians should be aware that removing a serotonin-2a (S-HT2a) antagonist 1mm a treatment regimen including an agent that increases serotonin in the synaptic cleft may worsen clozapine withdrawal or potentially result in serious adverse drug reactions, such as serotonin syndrome.

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Clomipramine; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Serotonin Syndrome; Substance Withdrawal Syndrome

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Clomipramine; Clozapine; Drug Therapy, Combination; Female; Humans; Obsessive-Compulsive Disorder; Schizophrenia, Disorganized; Treatment Outcome

In the examination in question, the case history of a patient who had exhibited serious obsessive-compulsive symptoms since the age of 14 is described. It is not an independent obsessive-compulsive disorder, but a case of schizophrenia masked by obsessive-compulsive symptoms. During therapy for the schizophrenic symptoms with clozapine, which set in at the age of 31, neither psychotic symptoms nor obsessive-compulsive symptoms worth mentioning can be found at the 1-year catamnesis. Whereas the literature increasingly points to obsessive-compulsive symptoms being a side-effect of clozapine medication, usually in the clinical indication area of chronic schizophrenic psychoses, as far as the author knows, this describes a rare case of improvement of obsessive-compulsive symptoms using clozapine after first suffering from a schizophrenic disorder. The meaning of differential diagnostics of obsessive-compulsive phenomena for adequate pharmacotherapy is discussed using the example of the individual case.

Topics: Adolescent; Adult; Antipsychotic Agents; Clozapine; Diagnosis, Differential; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Antipsychotic Agents; Clozapine; Comorbidity; Drug Therapy, Combination; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Paroxetine; Schizophrenia; Schizophrenic Psychology; Selective Serotonin Reuptake Inhibitors; Treatment Outcome

The increase or emergence of obsessions was compared in young patients with recent-onset schizophrenia or other psychotic disorders taking clozapine and other antipsychotic drugs.. We conducted a retrospective cohort study. Subjects were 121 consecutively admitted patients diagnosed with DSM-III-R schizophrenia, schizoaffective disorder, schizophreniform disorder, or psychotic disorder not otherwise specified. Obsessions were diagnosed according to DSM-IV criteria.. More clozapine-treated subjects (20.6%) than subjects treated with other antipsychotic drugs (1.3%) experienced an emergence or increase of obsessions (p<.01).. Use of clozapine is associated with the emergence or increase of obsessions in early-phase schizophrenia.

Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Female; Humans; Male; Obsessive-Compulsive Disorder; Psychotic Disorders; Retrospective Studies; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

Clozapine is an atypical antipsychotic agent for the treatment of schizophrenic patients whose symptoms do not respond to traditional antipsychotic drugs. The emergence of obsessive-compulsive symptoms during treatment of clozapine has been reported in some case studies. We report on the case of a 31-year old man with chronic schizophrenia who had shown obsessive-compulsive symptoms during treatment with clozapine.. A 31-year old patient with treatment refractory schizophrenia was treated with clozapine. During clozapine treatment, positive symptomatology decreased, but after 4 months after starting clozapine the patient showed obsessive and compulsive symptoms. This symptomatology had previously not been a feature of this patient's illness.. Obsessive-compulsive symptoms were observed during treatment of clozapine in a schizophrenic patient. This may be explained either by the serotonin-receptor antagonism of clozapine or its atypical dopaminergic receptor effects.

Topics: Adult; Antipsychotic Agents; Chronic Disease; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

Topics: Adult; Clozapine; Female; Humans; Obsessive-Compulsive Disorder; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Clozapine; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Antipsychotic Agents; Clozapine; Cytochrome P-450 CYP1A2; Drug Interactions; Fluvoxamine; Humans; Obsessive-Compulsive Disorder

Topics: Adult; Benztropine; Clozapine; Edema; Female; Humans; Obsessive-Compulsive Disorder; Parotid Diseases; Sialorrhea

Topics: 1-Naphthylamine; Adult; Clozapine; Drug Therapy, Combination; Humans; Lithium; Male; Obsessive-Compulsive Disorder; Psychotic Disorders; Selective Serotonin Reuptake Inhibitors; Sertraline; Treatment Outcome; Valproic Acid

We report on a 27-year-old woman with previously therapy-resistant obsessive-compulsive disorder and emotionally unstable personality disorder, borderline type, which improved considerably on treatment with clozapine. Previous treatment attempts with paroxetine, clomipramine and various classic and atypical neuroleptics, as well as extensive psychotherapeutic treatment, had proved ineffective.

Topics: Adult; Aggression; Antipsychotic Agents; Borderline Personality Disorder; Clozapine; Female; Humans; Obsessive-Compulsive Disorder

Topics: Adult; Antipsychotic Agents; Clozapine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Obsessive-Compulsive Disorder; Risperidone; Schizophrenia, Disorganized; Stereotyped Behavior

Interest in the association of obsessive-compulsive (OC) symptoms and schizophrenia has been reawakened since the introduction of clozapine for treatment of schizophrenia. We describe the appearance of this disorder and examine the efficacy of adding fluvoxamine to ongoing clozapine treatment of the OC and schizophrenic symptoms. Four patients with DSM-III-R schizophrenic disorder, in whom OC symptoms appeared during the course of clozapine treatment, are reported. In two patients, fluvoxamine, a serotonin-selective reuptake inhibitor (SSRI), was added to clozapine under open-trial conditions. The patients were serially assessed by using the Brief Psychiatric Rating Scale, Yale-Brown Obsessive-Compulsive Scale, and Scale for the Assessment of Negative Symptoms. The de novo occurrence and eventual spontaneous reduction of OC symptoms were noted in two schizophrenic patients treated with clozapine. In the other two patients, one with previous and the other with a family history of OC disorder, the addition of fluvoxamine to clozapine was effective in eliminating the OC symptoms. A concomitant improvement in the schizophrenic symptomatology was seen as well. It appears that disabling OC symptoms may occur as in response to clozapine treatment in chronic drug-resistant schizophrenic patients. Some of the latter may benefit from the addition of an SSRI to the ongoing clozapine regimen.

Topics: Adult; Clozapine; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adult; Bulimia; Clozapine; Dose-Response Relationship, Drug; Drug Monitoring; Drug Therapy, Combination; Female; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adolescent; Clozapine; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia

Topics: Adult; Clozapine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology

Topics: Brain; Clozapine; Humans; Obsessive-Compulsive Disorder; Receptors, Serotonin; Schizophrenia; Schizophrenic Psychology

Topics: Clozapine; Humans; Obsessive-Compulsive Disorder; Recurrence; Schizophrenia; Schizophrenic Psychology

Topics: 1-Naphthylamine; Clozapine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Adult; Clozapine; Humans; Male; Obsessive-Compulsive Disorder

Topics: Adult; Clozapine; Haloperidol; Humans; Male; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology

Topics: Clozapine; Drug Therapy, Combination; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology

Topics: Clozapine; Drug Therapy, Combination; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Receptors, Serotonin

Topics: Adult; Clozapine; Female; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Schizophrenia

Clozapine differs from other currently available antipsychotics in its prominent serotonin blockade. We explore the relationship between clozapine and obsessive compulsive symptoms, which have been linked to deficient serotonin.. We reviewed our experience in treating 49 chronic schizophrenic patients with clozapine.. Five patients were identified who experienced either de novo obsessive compulsive symptoms or exacerbation of preexistent symptoms. Clinical details are provided for each case.. Clozapine may produce or unmask obsessive compulsive symptoms. This may reflect a variation on the normal course of clinical improvement, or may more specifically result from clozapine's atypical pattern of CNS receptor antagonism. Further attention to this issue is warranted.

Topics: Adult; Chronic Disease; Clozapine; Female; Humans; Male; Obsessive-Compulsive Disorder; Receptors, Dopamine; Receptors, Serotonin; Schizophrenia; Schizophrenic Psychology

Topics: Adult; Clozapine; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenic Psychology