Obsessive-compulsive disorder clozapine

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. 

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Levin Z, Hwang MY, Rotrosen J. The relationship between clozapine and obsessive-compulsive disorder. Compr Psychiatry 1996 37 74. Oshika T. Ocular adverse effects of neuropsychiatric agents Incidence and management. Drug Saf 1995 12 256-263. 

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%). 

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 ]. 

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

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