Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature

anon79999497 · October 17, 2014, 5:55am

ncbi.nlm.nih.gov

Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature.

TM Fonseka, MA Richter and DJ Müller, Current psychiatry reports, Nov 2014

Second generation antipsychotics (SGAs) have been implicated in the de novo emergence and exacerbation of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Among SGAs, clozapine, olanzapine, and risperidone are the most prominent agents associated with these sequelae, according to case reports. Comorbid OCS can impede recovery by compromising treatment benefits, medication compliance, and clinical prognoses. Previous reviews of SGA-induced OCS have predominantly focused on descriptive case reports, with limited attention paid toward experimental findings. To address this paucity of data, we sought to review the effects of SGAs on OCS in schizophrenia in the experimental literature, while addressing the role of different treatment (duration, dose, serum levels) and pharmacogenetic factors. Our findings suggest that clozapine confers the greatest risk of OCS in schizophrenia, with 20 to 28% of clozapine-treated patients experiencing de novo OCS, in addition to 10 to 18% incurring an exacerbation of pre-existing OCS. Clozapine can also yield full threshold obsessive-compulsive disorder (OCD), in some cases. Olanzapine is another high risk drug for secondary OCS which occurs in 11 to 20% of schizophrenic patients receiving olanzapine therapy. At this time, there is insufficient experimental evidence to characterize the effects of other SGAs on OCS. Despite some experimental support for the involvement of longer treatment duration and genetic factors in mediating drug-induced OCS, more research is needed to clearly elucidate these associations. Based on these results, schizophrenic patients should be routinely monitored for OCS throughout the course of SGA treatment, particularly when clozapine or olanzapine is administered.

green5 · October 17, 2014, 6:33am

Hi, Firemonkey, this is interesting . What are Obsessive-Compulsive Symptoms? Can you give an example?

anon79999497 · October 17, 2014, 6:42am

OCD signs and symptoms: Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:

Fear of being contaminated by germs or dirt or contaminating others.
Fear of causing harm to yourself or others.
Intrusive sexually explicit or violent thoughts and images.
Excessive focus on religious or moral ideas.
Fear of losing or not having things you might need.
Order and symmetry: the idea that everything must line up “just right.”
Superstitions; excessive attention to something considered lucky or unlucky.

OCD signs and symptoms: Compulsive behaviors

Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:

Excessive double-checking of things, such as locks, appliances, and switches.
Repeatedly checking in on loved ones to make sure they’re safe.
Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
Spending a lot of time washing or cleaning.
Ordering or arranging things “just so.”
Praying excessively or engaging in rituals triggered by religious fear.
Accumulating “junk” such as old newspapers or empty food containers.

http://www.ocduk.org/types-ocd

Dreamscape · October 17, 2014, 6:48am

The weird thing is my mania is controlled by my OCD symptoms since I’ve been on risperidone. I spend the energy getting very organised, cleaning etc. So not necessarily a bad thing, in my case anyway.

green5 · October 17, 2014, 6:51am

Thank you, firemonkey, you are so helpful…

Dreamscape · October 17, 2014, 12:58pm

Yes and how many times have you had to stop yourself from moving the lawn at 3am in the morning? P.s Are some that say the first sign of madness is talking to yourself!!!

Wave · October 17, 2014, 2:02pm

I have to remind myself to tell my pdoc that I am almost positive the Lamictal I am taking has increased my OCD symptoms - I am pretty sure that this mood stabilizer has the propensity to do this

metime · October 17, 2014, 6:44pm

My family genes prevent my Risperdal from causing too many OCD symptoms, because we have the exact opposite of OCD. We are messy, we hoard a bit, but we’re mostly messy. If anything, the Risperdal has corrected me to being more normal.