A cross sectional study of impact and clinical risk factors of antipsychotic-induced OCD

Marjan Biria,Emilio Fernandez-Egea,Naomi A. Fineberg,Yulia Worbe,Fiona-Xiaofei Huang,Trevor W. Robbins

doi:10.1016/j.euroneuro.2019.06.006

Abstract

A large proportion of schizophrenia patients treated with second generation antipsychotics will develop Obsessive Compulsive Disorder (OCD). However, there are few studies about the impact of this comorbidity and who is at higher risk. In this study of clozapine-treated patients, we aimed to determine the impact on outcome of clozapine-induced OCD, as well as the clinical and sociodemographic risk factors related to OCD-onset in clozapine patients. We had strict and novel inclusion criteria to minimise mis-identification of cases. The Obsessive-Compulsive Inventory-Revised (OCI-R) was used to divide 231 clozapine-treated patients into extreme cases of OCD (OCI ≥ 24 or checking subscale ≥6) versus non-OCD (OCI <15 and checking subscale <4). The Global Assessment of Functioning (GAF), short version of Warwick-Edinburgh Wellbeing scale and Clinical Global Impression for schizophrenia (CGI) scales were used to determine outcome. Socio-demographic information was used to identify the risk factors for OCD development. We found that schizophrenia patients with OCD symptoms had a significantly lower patient rated wellbeing scores (p < 0.001) only (no difference in clinician rated wellbeing scores), higher CGI positive (p < 0.01) and higher CGI depressive scores (p < 0.05). The only risk factors that reached significance level were higher treatment dose (p < 0.01) and younger paternal age at birth (p < 0.05). There is scope for future studies based on e.g. imaging and genetic studies to further investigate causality, and in improving clinician screening for OCD.

Highlights

A large proportion of schizophrenia patients treated with second generation antipsychotics will develop Obsessive Compulsive Disorder (OCD)
Several studies have shown that schizophrenia patients treated with second generation antipsychotics will develop symptoms of obsessive-compulsive disorder (OCD) (Schirmbeck and Zink, 2012) with the proportion being around half (FernandezEgea et al, 2018)
To identify the risk factors for developing OCD, we used the following list of potential risk factors for both antipsychotic-induced OCD and general OCD literature: paternal and maternal age, birth weight, hand dominance, family history of psychosis and OCD, age at presentation of schizophrenia, gender, treatment dose and duration, smoking habit, comorbidities with other psychiatric disorders and whether or not the psychosis was initially triggered by drug use

Summary

Introduction

A large proportion of schizophrenia patients treated with second generation antipsychotics will develop Obsessive Compulsive Disorder (OCD). Several studies have shown that schizophrenia patients treated with second generation antipsychotics will develop symptoms of obsessive-compulsive disorder (OCD) (Schirmbeck and Zink, 2012) with the proportion being around half (FernandezEgea et al, 2018). Even the exact mechanism and prevalence of antipsychotic-induced OCD remain unclear Those antipsychotics with greater anti-serotoninergic action, such as clozapine and olanzapine, have been more often associated with OCD onset (Poyurovsky et al, 2001; Schirmbeck et al, 2011). Recent study pointed to the possibility of co-prevalence of motor disorders prior to OCD development in psychotic disorders (Fineberg et al, 2017; Swets et al, 2018) These findings need further replication in larger samples

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