Abstract
Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions. The electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined. OCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity. Screening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients.
Highlights
Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients the actual prevalence, phenomenology and risk factors remain unclear
Obsessive–compulsive disorder (OCD) is common in schizophrenia patients treated with antipsychotics with significant anti-serotoninergic action (Swets et al 2014; Grillault Laroche & Gaillard, 2016)
Stricter criteria were defined for the analysis of the role of clozapine dose and plasma level on OCD severity, i.e: only cases on clozapine monotherapy, with clozapine plasma levels available and with evidence of adequate medication compliance measured by the clozapine:norclozapine ratio, were included
Summary
Obsessive–compulsive disorder (OCD) is common in schizophrenia patients treated with antipsychotics with significant anti-serotoninergic action (Swets et al 2014; Grillault Laroche & Gaillard, 2016). Most studies of prevalence have not taken into account psychosis severity (Poyurovsky et al 2001; Lin et al 2006; Faragian et al 2009; Mukhopadhaya et al 2009). One study found that patients with clozapine-associated OCD were treated with higher drug doses (Mukhopadhaya et al 2009), and another study (Schirmbeck et al 2011) showed a correlation between dose and OCD symptoms but failed to correlate with clozapine plasma levels. No study has found a correlation between clozapine plasma levels and obsessive and compulsive symptom (OCS) severity (Lin et al 2006; Schirmbeck et al 2011)
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