Obsessive-compulsive symptoms clozapine

Selective serotonin reuptake inhibitors have been used with FGAs with improvement of negative symptoms. Selective serotonin reuptake inhibitors have been used for obsessive-compulsive symptoms that worsen or arise during clozapine treatment. 

Lin, S. K., Su, S. F., and Pan, C. H. (2006) Higher plasma drug concentration in clozapine-treated schizophrenic patients with side effects of obsessive/compulsive symptoms. Ther. Drug Monit. 28, 303-307. 

Baker RW, Chengappa KNR, Baird JW, et al Emergence of obsessive compulsive symptoms during treatment with clozapine. J Chn Psychiatry 53 439-442, 1992... 

Dursun SM, Reveley MA Obsessive-compulsive symptoms and clozapine (letter). Br J Psychiatry 165 267-268, 1994... 

Bales MG, Layeni AO Exacerbation of obsessive-compulsive symptoms associated with clozapine. Br J Psychiatry 164 687-688, 1994 Eaton SA, Salt TE Modulatory effects of serotonin on excitatory amino acid responses and sensory synaptic transmission in the ventrobasal thalamus. Neuroscience 33 285-292, 1989... 

Patel B, Tandon R Development of obsessive-compulsive symptoms during clozapine treatment. Am J Psychiatry 150 836, 1993... 

Patel J, Keith RA, Salama AI, et al Role of calcium in regulation of phosphoinositide signaling pathway. J Mol Neurosci 3 1-9, 1991 Patil VJ Development of transient obsessive-compulsive symptoms during treatment with clozapine. Am J Psychiatry 149 272, 1992 Pato MT, Zohar-Kadouch R, Zohar J, et al Return of symptoms after discontinuation of CMl in patients with OCD. Am J Psychiatry 145 1521-1522, 1988 Pato PT, Pigott TA, Hill JL, et al Controlled comparison of buspirone and CMl in OCD. Am J Psychiatry 148 127-129, 1991 Patterson JF Treatment of acute mania with verapamil (letter). J Clin Psycho-pharmacol 7 206-207, 1987... 

Obsessive-compulsive symptoms. Clozapine has been reported to exacerbate symptoms of obsessive-compulsive disorder, probably because of 5-HT2 antagonism (Ghaemi et al. 1995). If this effect occurs, symptoms are usually controlled with the addition of an SSRI. 

Obsessive-compulsive symptoms have been described with both typical neuroleptic drugs (for example chlor-promazine) and atypical drugs (for example clozapine and risperidone) (SEDA-19, 51 SEDA-20, 47 407,410). 

Obsessive-compulsive symptoms during clozapine therapy have been suggested to be more common than first reported (SEDA-21, 54). In a retrospective cohort study, new or worse obsessiveness has been analysed in 121 consecutive young patients with recent-onset schizophrenia or other psychotic disorders taking clozapine and other neuroleptic drugs (108). More clozapine-treated subjects (21%) had new or worse obsessiveness than subjects treated with other neuroleptic drugs (1.3%). 

Four patients had severe dystonias and dyskinesias on abrupt withdrawal of clozapine (216), and another two had obsessive-compulsive symptoms during withdrawal resumption of clozapine led to the complete disappearance of the obsessive-compulsive symptoms (217). 

Weizman A. Emergence of obsessive-compulsive symptoms and tics during clozapine withdrawal. Clin 238. 

Obsessive-compulsive symptoms worsened in a 35-year-old man who had had a similar response to both clozapine and risperidone in previous trials (148). 

Poyurovsky M, Bergman Y, Shoshani D, Schneidman M, Weizman A. Emergence of obsessive-compulsive symptoms and tics during clozapine withdrawal. Clin Neuropharmacol 1998 21(2) 97-100. 

Exacerbation and new onset of obsessive-compulsive symptoms have been reported with clozapine, and has anecdotally been reported to improve with addition of an SSRI. ... 

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 ]. 

Psychiatric Obsessive-compulsive symptoms are reported to occur in up to 40% of patients receiving clozapine for the treatment of schizophrenia however, two cases are reported in patients with bipolar disorder [IIS ]. 

Nervous System Parkinsonism was present in 46% of 150 elderly patients being treated with haloperidol and xmrelated to plasma concentrations or duration of use [151 ]. Two cases of neuroleptic-induced catatonia following the administration of intravenous haloperidol are described both patients recovered following discontinuation of haloperidol [152 ]. A case of neuroleptic malignant syndrome in a 48-year-old male is reported with index exposure to intravenous haloperidol that resolved on discontinuation [153 ]. Obsessive-compulsive symptoms are associated with a number of SGAs particularly clozapine however a case report describes the development of obsessive-compulsive symptoms in a learning disability patient treated with haloperidol [154 ]. 

Psychiatric A case of pathological stealing is reported following treatment with quetiapine and resolving after treatment with amisulpride in a 17-year-old female suffering from schizophrenia [224 ]. Suggested mechanisms may include frontal lobe disinhibition or obsessive-compulsive symptoms that have been reported with SGAs, notably clozapine and to a lesser extent with quetiapine. 

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. 

Lemke NT, BustiUo JR. Clozapine-induced obsessive-compulsive symptoms in bipolar disorder. Am J Psychiatry 2013 170(8) 930. 

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