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Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review - PubMed

Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review

Frederike Schirmbeck et al. Curr Neuropharmacol. 2012 Mar.

Abstract

Obsessive-compulsive disorder (OCD) is rarely associated with schizophrenia, whereas 20 to 30% of schizophrenic patients, suffer from comorbid obsessive-compulsive symptoms (OCS). So far no single pathogenetic theory convincingly explained this fact suggesting heterogeneous subgroups. Based on long-term case observations, one hypothesis assumes that second-onset OCS in the course of schizophrenia might be a side effect of second generation antipsychotics (SGA), most importantly clozapine (CLZ). This review summarizes the supporting epidemiological and pharmacological evidence: Estimations on prevalence of OCS increase in more recent cross-sectional studies and in later disease stages. Longitudinal observations report the de novo-onset of OCS under clozapine treatment. This association has not been reported with first generation antipsychotics (FGA) or SGAs with mainly dopaminergic mode of action. Finally, significant correlations of OCS-severity with duration of treatment, dose and serum levels suggest clozapine-induced OCS. However, supposed causal interactions need further verifications. It is also unclear, which neurobiological mechanisms might underlie the pathogenetic process. Detailed genotypic and phenotypic characterizations of schizophrenics with comorbid OCS regarding neurocognitive functioning and activation in sensitive tasks of functional magnetic imaging are needed. Multimodal large-scaled prospective studies are necessary to define patients at risk for second-onset OCS and to improve early detection and therapeutic interventions.

Keywords: Clozapine; comorbidity; compulsive; obsessive; pharmacology; schizophrenia; serotonin..

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References

    1. Poyurovsky M, Weizman A, Weizman R. Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs. 2004;18(14):989–1010. - PubMed
    1. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr. Bull. 2009;35(2):383–402. - PMC - PubMed
    1. Mukhopadhaya K, Krishnaiah R, Taye T, Nigam A, Bailey AJ, Sivakumaran T, Fineberg NA. Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause for clinical concern. J. Psychopharmacol. 2009;23(1):6–13. - PubMed
    1. Lysaker PH, Whitney KA. Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment. Expert Rev. Neurother. 2009;9(1):99–107. - PubMed
    1. Achim AM, Maziade M, Raymond E, Olivier D, Merette C, Roy MA. How prevalent are anxiety disorders in Schizophrenia? A meta-analysis and critical review on a significant association. Schizophr. Bull. 2011;37(4):811–21. - PMC - PubMed

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