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Pharmacopsychiatry 2004; 37(2): 52-56
DOI: 10.1055/s-2004-815525
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Clozapine in the Treatment of Obsessive-compulsive Symptoms in Schizophrenia Patients: A Case Series Study

I. Reznik1 , 2 , 3 , I. Yavin1 , R. Stryjer2 , B. Spivak1 , 3 , N. Gonen1 , 3 , R. Strous2 , 3 , R. Mester1 , 3 , A. Weizman3 , M. Kotler2 , 3
  • 1Ness-Ziona Mental Health Center, Ness-Ziona, Israel
  • 2Beer-Yakov Mental Health Center, Beer-Yakov, Israel
  • 3Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
No financial or material support was received from any external resource for this work
Further Information

Publication History

Received: 7.6.2002 Revised: 26.9.2002

Accepted: 17.1.2003

Publication Date:
29 March 2004 (online)

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Introduction: Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. There are some reports describing the appearance de novo or reemergence of preexisting OC symptoms under clozapine (CLZ) therapy. However, there are also reports describing a positive effect of CLZ therapy in OC schizophrenic patients. It seems that comorbid OC symptoms are common among CLZ-treated refractory schizophrenic patients and are likely to be an integral part of their illness. The complex nature of the treatment response in this group of schizophrenic patients is as yet unclear. The effects of CLZ on OC symptoms may vary, with evidence of improvement in some and worsening among others. Methods: The present case series study describes our experience with CLZ as a sole agent (n = 10) or in combination with serotonin reuptake inhibitors (n = 5), in schizophrenic patients with prominent OC symptomatology. Results: Systematic analysis of clinical features of our patients, as well as findings in the literature to date, led us to suggest some factors that may predict response to CLZ treatment in treatment-resistant schizophrenic patients with prominent OC symptoms: 1) schizophrenic patients who began to exhibit OC symptoms within the course of the psychotic process need and might to be successfully treated with CLZ alone; 2) when OC symptomatology preceded the development of schizophrenic process, CLZ monotherapy is inefficient and may even worsen OC symptoms; therefore, it should be treated concomitantly with specific anti-obsessive agents; 3) in both groups there is a definite dose-related pro-obsessive influence of CLZ when it is given in high doses. Discussion: Further controlled investigations in a larger cohort of OC schizophrenic patients are needed to substantiate our hypothesis.

Abbreviations

OCD:Obsessive-compulsive disorder

OCS:Obsessive-compulsive symptoms

SRI:Serotonin reuptake inhibitors

References

  • 1 Allen L, Tejera C. Treatment of clozapine-induced obsessive-compulsive symptoms with sertraline (letter).  Am J Psychiat. 1994;  151 1096-1097
    PubMedGoogle Scholar
  • 2 Baker R W, Ames D, Umbricht D S, Chengappa K N, Schooler N R. Obsessive-compulsive symptoms in schizophrenia: a comparison of olanzapine and placebo.  Psychopharmacol Bull. 1996;  32 89-93
    PubMedGoogle Scholar
  • 3 Baker R W, Bermanzohn P C, Wirshing D A, Chengappa K NR. Obsessions, compulsions, clozapine, and risperidone.  CNS Spectrums.. 1997;  2 26-36
    PubMedGoogle Scholar
  • 4 Baker R W, Chengappa K N, Baird J W, Steingard S, Christ M A, Schooler N R. Emergence of obsessive compulsive symptoms during treatment with clozapine.  J Clin Psychiat. 1992;  53 439-442
    PubMedGoogle Scholar
  • 5 Berman I, Chang H H, Klegon D A. Is there a distinct subtype of obsessive-compulsive schizophrenia?.  Psychiatric Ann. 1999;  30 652-649
    PubMedGoogle Scholar
  • 6 Berman I, Merson A, Viegner B, Losonczy M F, Pappas D, Green A I. Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study.  J Nerv Ment Dis. 1998;  186 150-156
    CrossrefPubMedGoogle Scholar
  • 7 Bermanzohn P C, Porto L, Arlow P, Pollack S, Stronger R, Siris S G. Are some neuroleptic-refractory symptoms in schizophrenia really obsessions?.  CNS Spectrums. 1997;  2 51-57
    PubMedGoogle Scholar
  • 8 Biondi M, Fedele L, Arcangeli T, Pancheri P. Development of obsessive-compulsive symptoms during clozapine treatment in schizophrenia and its positive response to clomipramine (letter).  Psychother Psychosom. 1999;  68 111-112
    PubMedGoogle Scholar
  • 9 Bland R C, Newman S C, Orn H. Schizophrenia: lifetime comorbidity in a community sample.  Acta Psychiat Scand. 1987;  75 383-391
    PubMedGoogle Scholar
  • 10 Buckley P F, Sajatovic M, Meltzer H Y. Treatment of delusional disorders with clozapine (letter).  Am J Psychiat. 1994;  151 1394-1395
    PubMedGoogle Scholar
  • 11 Burgy M. Clozapine and obsessive-compulsive symptoms in schizophrenia. A case history of one patient.  Nervenarzt. 1999;  70 64-67
    CrossrefPubMedGoogle Scholar
  • 12 Cassady S L, Thaker G K. Addition of fluoxetine to clozapine) letter).  Am J Psychiatry. 1992;  149 27
    PubMedGoogle Scholar
  • 13 Centorrino F, Baldessarini R J, Frankenburg F R, Kando J, Volpicelli S A, Flood J G. Serum levels of clozapine and norclozapine in patients treated with selective serotonin reuptake inhibitors.  Am J Psychiat. 1996;  153 820-822
    PubMedGoogle Scholar
  • 14 Chang H H, Berman I. Treatment issues for patients with schizophrenia who have obsessive-compulsive symptoms. Psychiatric Ann 1999: 529-532
    Google Scholar
  • 15 de Haan L, Linszen D H, Gorsira R. Clozapine and obsessions in patients with recent-onset schizophrenia and other psychotic disorders.  J Clin Psychiat. 1999;  60 364-365
    PubMedGoogle Scholar
  • 16 Eales M J, Layeni A O. Exacerbation of obsessive-compulsive symptoms associated with clozapine) letter).  Br J Psychiat. 1994;  164 687-688
    PubMedGoogle Scholar
  • 17 Fenton W S, McGlashan T H. The prognostic significance of obsessive-compulsive symptoms in schizophreni.  Am J Psychiat. 1986;  143 437-441
    PubMedGoogle Scholar
  • 18 First M B, Spitzer R L, Gibbon M, Williams J BW. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). New York; New York State Psychiatric Institute, Biometrics Research 1995
    Google Scholar
  • 19 Ghaemi S N, Zarate C A, Popli A P, Pillay S S, Cole J O. Is there a relationship between clozapine and obsessive-compulsive disorder. A retrospective chart review?.  Compr Psychiat. 1995;  36 267-270
    CrossrefPubMedGoogle Scholar
  • 20 Goodman W K, Price L H, Rasmussen S A, Mazure C, Fleismann R L, Hill C L, Heninger G R, Charney D S. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), I: development, use and reliability.  Arch Gen Psychiat. 1989;  46 1006-1011
    PubMedGoogle Scholar
  • 21 Hwang M Y, Hollander E. Schizo-obsessive disorders.  Psychiatr Ann. 1993;  23 396-401
    PubMedGoogle Scholar
  • 22 Karno M, Golding J M, Sorenson S B, Burnbaum R A. The epidemiology of obsessive compulsive disorder in 5 U.S. communities.  Arch Gen Psych. 1988;  45 1094-1099
    PubMedGoogle Scholar
  • 23 Kay S R, Fiszbein A, Opler L A. The positive and negative syndrome scale (PANSS) for schizophrenia.  Schizophr Bull. 1987;  13 261-276
    CrossrefPubMedGoogle Scholar
  • 24 La Porta L D. More on obsessive-compulsive symptoms and clozapine.  J Clin Psychiat. 1994;  55 312
    PubMedGoogle Scholar
  • 25 Patel B, Tandon R. Development of obsessive-compulsive symptoms during clozapine treatment) letter).  Am J Psychiat. 1993;  150 836
    PubMedGoogle Scholar
  • 26 Patil V J. Development of transient obsessive-compulsive symptoms during treatment with clozapine (letter).  Am J Psychiat. 1992;  149 272
    PubMedGoogle Scholar
  • 27 Poyurovsky M, Dorfman-Etrog P, Hermesh H, Munitz H, Tollefson G D, Weizman A. Beneficial effect of olanzapine in schizophrenic patients with obsessive-compulsive symptoms.  Int Clin Psychopharmacol. 2000;  15 169-173
    CrossrefPubMedGoogle Scholar
  • 28 Poyurovsky M, Hermesh H, Weizman A. Fluvoxamine treatment in clozapine-induced obsessive-compulsive symptoms in schizophrenic patients.  Clin Neuropharmacol. 1996;  19 305-313
    CrossrefPubMedGoogle Scholar
  • 29 Poyurovsky M, Hramenkov S, Isakov V, Rauchverger B, Modai I, Schneidman M, Fuchs C, Weizman A. Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia.  Psychiatry Res. 2001;  102 49-57
    CrossrefPubMedGoogle Scholar
  • 30 Poyurovsky M, Weizman A. Beneficial effect of clozapine in schizophrenic patients with comorbid obsessive-compulsive symptoms (abstract. (Presented at the 150-th Annual Meeting of the APA. 1997 San Diego, Ca, USA, (b): 136;
    Google Scholar
  • 31 Reznik I, Sirota P. Obsessive-compulsive symptoms in schizophrenia: a randomized controlled trial with SSRI’s and neuroleptics.  J Clin Psychopharmacol. 2000;  20 410-416
    CrossrefPubMedGoogle Scholar
  • 32 Reznik I, Mester R, Kotler M, Weizman A. Obsessive-compulsive schizophrenia: a new diagnostic entity.  J Neuropsychiat Clin Neurosci. 2001;  13 115-116
    PubMedGoogle Scholar
  • 33 Robinson S, Winnik H Z, Weiss A A. ”Obsessive psychosis”: justification for a separate clinical entity.  Isr Ann Psychiatr Relat Discip. 1976;  14 39-48
    PubMedGoogle Scholar
  • 34 Strous R D, Patel J K, Zimmet S, Green A I. Clozapine and paroxetine in the treatment of schizophrenia with obsessive-compulsive features (letter).  Am J Psychiat. 1999;  156 973-974
    PubMedGoogle Scholar
  • 35 Taflinsky T. Obsessive-compulsive symptoms in schizophrenic patients treated with clozapine (abstract).  Eur Neuropsychopharmacol. 2000;  36 (suppl) P.2.074
    PubMedGoogle Scholar
  • 36 Tibbo P, Gendemann K. Improvement of obsessions and compulsions with clozapine in an individual with schizophrenia (letter).  Can J Psychiatry. 1999;  44 1049-1050
    PubMedGoogle Scholar
  • 37 Tibbo P, Warneke L. Obsessive-compulsive disorder in schizophrenia: epidemiologic and biologic overlap.  J Psychiatry Neurosci. 1999;  24 15-24
    PubMedGoogle Scholar
  • 38 Voruganti L NP, Tremblay C, Awad A G. A prospective study of obsessive-compulsive symptoms during clozapine therapy. [poster NR 504]. Presented at the 154-th Annual Meeting of APA. 2001 New Orleans, La., USA;
    Google Scholar
  • 39 Wetzel H, Anghelescu I, Szegedi A, Wiesner J, Weigmann H, Harter S, Hiemke C. Pharmacokinetic interactions of clozapine with selective serotonin reuptake inhibitors: differential effects of fluvoxamine and paroxetine in a prospective study.  J Clin Psychopharmacol. 1998;  18 2-9
    CrossrefPubMedGoogle Scholar
  • 40 Young C R, Bostic J Q, McDonald C L. Clozapine and refractory obsessive-compulsive disorder: a case report.  J Clin Psychopharmacol. 1994;  14 209-211
    PubMedGoogle Scholar
  • 41 Zohar J. Is there room for a new diagnostic subtype - the schizo-obsessive subtype?.  CNS Spectrums. 1997;  2 49-50
    PubMedGoogle Scholar

Dr. Ilya Reznik

Lod Community Mental Health Center

# 140 Katzenelson Street

Lod

71226, IL

Phone: 972-8-9213993

Fax: 972-8-9216038

Email: ilyarez@netvision.net.il

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