Abstract
Obsessive-compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms. We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice. We used statistical mixed linear model techniques to evaluate the longitudinal influence of OCS severity on wellbeing and general functioning. A total of 184 patients were included, with 527 face-to-face assessments and 64.7% evaluated three or more times. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Obsessional thinking and hoarding behaviour, but not compulsions, were significantly associated with the impact on wellbeing, which may be attributable to the ego-syntonic nature of the compulsions. Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine.
Highlights
People with schizophrenia diagnoses experience lower subjective wellbeing compared to the general population (Maat, Fett, Derks, & Investigators, 2012; Ritsner et al, 2000)
A total of 184 individuals were included in the study, with a total of 527 assessments in which Obsessive–Compulsive Inventory – Revised (OCI-R), Short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS) and Global Assessment of Functioning Scale (GAF) were completed on the same day
We found that Obsessive–compulsive symptoms (OCS) experienced by patients treated with clozapine were significantly associated with worse wellbeing, but did not impair general functioning, as measured by self-report using the Short Warwick–Edinburgh Mental Wellbeing Scale and by clinician report using the Global Assessment of Functioning scale, respectively
Summary
People with schizophrenia diagnoses experience lower subjective wellbeing compared to the general population (Maat, Fett, Derks, & Investigators, 2012; Ritsner et al, 2000). In previous work (Fernandez-Egea, Worbe, Bernardo, & Robbins, 2018), we found that 47% of patients treated with clozapine (40% of whom were treated with clozapine for over 20 years) developed significant OCS, measured by the Obsessive–Compulsive Inventory – Revised (OCI-R; Foa et al, 2002) This proportion is three times higher than in patients diagnosed with schizophrenia. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine
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