Abstract
A large subgroup of schizophrenia patients suffers from obsessive-compulsive symptoms (OCS). The patterns of OCS onset and longitudinal course significantly differ, most likely due to a so far incompletely understood interaction of genetic and environmental factors. One subgroup experiences the de novo onset or marked aggravation of pre-existing OCS during treatment with second-generation antipsychotics (SGAs). Substances such as clozapine and olanzapine balance their antidopaminergic effects with a potent antagonism at serotonin receptors. It has been proposed that these pharmacodynamic properties might have a pro-obsessive effect. Several epidemiological and pharmacological arguments substantiate this assumption of second-onset OCS as a widely under-recognised adverse event. Patients who suffer from SGA-induced OCS present with more pronounced cognitive deficits and show differential patterns of brain activation during functional magnetic resonance imaging using OCS-sensitive tasks. Specific genetic risk factors seem to dispose patients with schizophrenia to develop OCS during SGA treatment. Further research is needed to investigate possible gene and environment interactions in more detail.
With respect to practical implications, clinicians should consider the risk of second-onset OCS prior to treatment initiation and provide this information to the patient as part of shared decision-making. Before the start of clozapine treatment, the antipsychotic of first choice in treatment-resistant schizophrenia, a careful diagnostic characterisation of OCS and neurocognitive abilities seems advisable. Longitudinal monitoring should aim at the early detection of OCS and evaluation of anti-obsessive interventions. This could include minimally sufficient dosages of pro-obsessive SGAs, which might be achieved by rational strategies of polypharmacy.
Keywords
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Learn about institutional subscriptionsAbbreviations
- AE:
-
Adverse event
- AMS:
-
Amisulpride
- APZ:
-
Aripiprazole
- ARMS:
-
At-risk mental state
- BDNF:
-
Brain-derived neurotrophic factor
- CBT:
-
Cognitive behavioural therapy
- CLZ:
-
Clozapine
- CR:
-
Case report
- CS:
-
Case series
- DLGAP3:
-
Discs large-associated protein 3
- ESM:
-
Experienced sampling methods
- fMRI:
-
Functional magnetic resonance imaging
- GxEI:
-
Gene and environment interaction
- OCD:
-
Obsessive-compulsive disorder
- OCS:
-
Obsessive-compulsive symptoms
- OFC:
-
Orbitofrontal cortex
- OLZ:
-
Olanzapine
- SGA:
-
Second-generation antipsychotics
- SLC1A1:
-
Solute carrier family gene 1A1
- SNP:
-
Single-nucleotide polymorphism
- SSRI:
-
Selective serotonin reuptake inhibitor
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Conflicts of Interest
F. S. was supported by a fellowship within the Postdoc-Programme of the German Academic Exchange Service (DAAD).
M. Z. received unrestricted scientific grants of the European Research Advisory Board (ERAB), German Research Foundation (DFG), Pfizer Pharma GmbH, Servier and Bristol-Myers Squibb Pharmaceuticals; further speaker and travel grants were provided from Janssen Cilag, Astra Zeneca, Lilly, Pfizer Pharma GmbH, Bristol-Myers Squibb Pharmaceuticals, Roche, Servier, Otsuka and Trommsdorff.
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Schirmbeck, F., Zink, M. (2015). Effects of Antipsychotic Treatment on Obsessive-Compulsive Symptoms. In: De Haan, L., Schirmbeck, F., Zink, M. (eds) Obsessive-Compulsive Symptoms in Schizophrenia. Springer, Cham. https://doi.org/10.1007/978-3-319-12952-5_10
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