Antipsychotics obsessive-compulsive

Although many schizophrenic patients demonstrate obsessive-compulsive symptoms, this problem has received little systematic investigation. There are conflicting case reports of patients with obsessive-compulsive symptoms who failed to benefit when given an antiobsessional drug in addition to an antipsychotic, and other cases in which this strategy was beneficial (176). There are also reports of certain repetitive behaviors that mimic OCD that are benefited by the addition of clomipramine (177,178 and 179). Schulz has proposed the term schizo-obsessive to describe this clinical presentation ( 180). 

In one single-blind study, 17 schizotypal patients were given a modest dose of halopehdol (i.e., 2 to 12 mg per day), which produced some benefit, although many were sensitive to the adverse effects of this drug (216). The study by Goldberg et al. (217) also found that thiothixene benefited both schizotypal disorder and borderline personality disorder (BPD). Similarly, low-dose antipsychotics had a modest effect in patients with both schizotypal and obsessive-compulsive personality disorders (218). 

Extension of this specificity principle to the clinical domain has resulted in the availability of increasingly well-aimed chemical bullets. If we wanted to block just one of the many serotonin receptors to see what would happen, we could probably do it But if we wanted to elevate mood in depression—or obsessive-compulsive disorder—would we expect the best result if we blocked just that one receptor And if we wanted to discourage auditory hallucinations in schizophrenia, would we want our drug to target only D2 dopamine receptors, even if we knew that the antipsychotic action of drugs correlated well with a drug s affinity for those receptors ... 

Tourette s syndrome (TS) is a chronic neurological disorder characterized by motor tics, involuntary verbalizations, and obsessive-compulsive behaviors. The current treatment lends itself to the use of antipsychotic agents. However, these treatments are only effective in about 70% of the treated population.84-85 Nicotine potentiates the behavioral effects of antipsychotics in a number of animal models.86 Clinical trials are under way involving patients receiving both nicotine and antipsychotic agents and appear to be promising.87 To date, there have been no studies mentioning the use of lobeline in TS. 

FIGURE 9—2. Various treatments can be given in combination for obsessive-compulsive disorder (OCD) (i.e., OCD combos). The basis of all combination treatments is a serotonin selective reuptake inhibitor (SSRI) or clomipramine. Added to this basis may be a serotonin 1A partial agonist, a serotonin 2A antagonist, lithium, a benzodiazepine or a sedative-hypnotic, a conventional antipsychotic or an atypical antipsychotic, or behavioral psychotherapy. 

Obsessive-compulsive symptoms developed in a 26-year-old Chinese woman taking risperidone for a chronic schizophrenic illness (134). She had no history of obsessive-compulsive symptoms. Risperidone 2 mg/ day, benzhexol 2 mg/day, and diazepam 10 mg at night had been prescribed after she had had adverse effects with other antipsychotic drugs. 

Augmentation with classical or atypical antipsychotics may be attempted when obsessive-compulsive disorder is resistant to antidepressant treatment... 

Basal ganglia Controls aspects of motor behavior Neuronal pathways connecting limbic system and prefrontal lobes Parkinson s disease, antipsychotic medication side effects (extrapyramidal symptoms (EPS)) Obsessive-compulsive disorder... 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

Psychiatric A naturalistic cross-sectional study of the prevalence of obsessive-compulsive symptoms in a population of patients with schizophrenia taking clozapine, olanzapine or risperidone or no antipsychotic found that the prevalence of the symptoms was higher for patients on antipsychotics and especially for patients on clozapine for more than 6 months [48 ]. 

Nervous System A case series of 20 refractory SSRI-treated patients with obsessive-compulsive disorder (OCD) received a single dose of amisulpride (400 mg), with eight patients experiencing acute akathisia and two an exacerbation of their OCD [87 ]. Anoculogyric crisis is an acute dystonic reaction associated witii high-potency antipsychotics but has not been reported following discontinuation. A case of oculogyric crisis is reported after discontinuation of amisulpride in a 26-year-old male patient previously treated for 2 years [88 ]. 

Scheltema Beduin AA, Swets M, Machielsen M, Korver N, Genetic Risk and Outcome of Psychosis Investigators. Obsessive-compulsive symptoms in patients with schizophrenia a naturalistic cross-sectional study comparing treatment with clozapine, olanzapine, risperidone, and no antipsychotics in 543 patients. J Ctin Psychiatry 2012 73(ll) 1395-402. 

---