Obsessive-compulsive symptoms

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. 

Eapen, V., Robertson, M.M., Alsobrook, J.R, 2nd, and Pauls, D.L. (1997) Obsessive compulsive symptoms in Gilles de la Tourette syndrome and obsessive compulsive disorder differences by diagnosis and family history. Am Med Genet 74 432 38. 

Leonard, H.L., Goldberger, E.L., Rapoport, J.L., Cheslow, D.L., and Swedo, S.E. (1990) Childhood rituals normal development or obsessive-compulsive symptoms / Am Acad Child Adolesc Psychiatry 29 17-23. 

Mordecai, D., Shaw, R.J., Eisher, P.G., Mittelstadt, P.A., Guterman, T., and Donaldson, S.S. (2000) Case study suprasellar germi-noma presenting with psychotic and obsessive-compulsive symptoms. / Am Acad Child Adolesc Psychiatry 39 116-119. 

In addition to tics, individuals with tic disorders may present with a broad array of behavioral difficulties including disinhibited speech or conduct, im-pulsivity, distractibility, motoric hyperactivity, and obsessive-compulsive symptoms (Leckman and Cohen, 1998). Alternatively, a sizable portion of children and adolescents with tics will be free of coexisting developmental or emotional difficulties. Scientific opinion has been divided on how broadly to conceive the spectrum of maladaptive behaviors associated with Tourette s syndrome (TS) (Comings, 1988 Shapiro et al., 1988). 

Asbahr FR, Ramos RT, Negrao AB, and Gentil V. (1999) Case Series increased vulnerability to obsessive-compulsive symptoms with repeated episodes of Sydenham chorea. J Am Acad Child Adolesc Psychiatry 38 1522-1525. 

Kiessling, L.S., Marcotte, A.C., and Culpepper, L. (1994) Antineuronal antibodies tics and obsessive-compulsive symptoms./ Dev Behav Pediatr 15 421-425. 

Can antidepressants such as tricyclics or buproprion augment the effect of stimulants on nondepressed children with ADHD Randomized controlled trials have yet to address this question. Nonetheless, such combinations are common in clinical practice. One case report showed leukopenia in a child treated with a combination of MPH and tricyclics for 4 months, although the doses were not specified (Burke et ah, 1995). Another case report indicated that obsessive-compulsive symptoms developed secondary to the combination of MPH and tricyclics (Pataki et ah, 1993). On a cautionary note, MPH has been found to interact with guanethidine to produce paradoxical hypotension. Patients on monoamine oxidose (MAO) inhibitors are likely to develop hypertensive crises if given a stimulant. 

Kurlan, R., Como, P.G., Deeley, C., McDermott, M., McDermott, M.P. (1993) A pilot controlled study of fluoxetine for obsessive-compulsive symptoms in children with Tourette s syndrome. Clin Neuropharmacol 16 167-172. 

Alzaid, K. and Jones, B.D. (1997) A case report of risperidone-induced obsessive compulsive symptoms./ Clin Psychopharmacol 17 58-59. 

Studies of the use of the specific serotonin-uptake inhibitors (SSRIs) to treat OCD suggest that, compared to non-tic-related OCD, tic-related OCD is less responsive to SSRI monotherapy (McDougle et al., 1993, 1994). Addition of a neuroleptic, such as haloperidol (McDougle et ah, 1994), risperidone (McDougle et al., 2000), or olanzapine (Bogetto et al., 2000), appears to be useful in improving treatment-resistant individuals response to a SSRI. It is unclear whether this pattern of treatment response is specifically associated with a comorbid tic disorder the pattern of obsessive compulsive symptoms characteristic of TS or yet some other predictors. 

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

Bark N, lindenmayer J-P Ineffectiveness of clomipramine for obsessive-compulsive symptoms in a patient with schizophrenia (letter). Am J Psychiatry 149 136-137, 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... 

Fenton WS, McGlashan TH The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry 143 437-441, 1986 Ferbert A, Priori A, RothwelJC, et al Interhemispheric inhibition of the human motor cortex. J Physiol Fond 453 525-546, 1992 Fergusson DM, Horwood Al, Lynskey MT Maternal depressive symptoms and depressive symptoms in adolescence. J Child Psychol Psychiatry 36 1161-1178, 1995... 

Koizumi HM Obsessive-compulsive symptoms following stimulants. Biol Psychiatry 20 1332-1333, 1985... 

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... 

Reiter RJ, Melchiorri D, Sewerynek E A review of the evidence supporting melatonin s role as an antioxidant. J Pineal Res 18 1-11, 1995 Reiter SR, Pollack S, Rosenbaum JF, et al Clonazepam for the treatment of social phobia. J Chn Psychiatry 51 470-472, 1990 Remington G, Adams M Risperidone and obsessive-compulsive symptoms [letter. ... 

Swedo SE, Rapoport JL, Cheslow DL, et al High prevalence of obsessive-compulsive symptoms in patients with Sydenham s chorea. Am J Psychiatry 146 246-249, 1989... 

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. 

Patient with obsessive-compulsive symptoms (or disorder) is nonresponsive on adequate blood levels consider clomipramine or an SSRI (e.g., fluoxetine, sertraline, paroxetine). 

The association with Gilles de la Tourette s disorder is particularly important. Although only a few OCD patients have tics, the prevalence is much higher than in the general population. Conversely, obsessive-compulsive symptoms are common in Tourette s patients. Thus, there is a clear association between Tourette s disorder and OCD. Tourette s is familial, and most likely genetically transmitted ( 157). Less is known about the heritability of OCD, but there is some suggestion that it is, at least in part, genetically determined (158, 159 and 160). 

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). 

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