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Polypharmacy for Obsessive-Compulsive Symptoms in Schizophrenia: Augmentation and Combination Strategies

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Obsessive-Compulsive Symptoms in Schizophrenia

Abstract

Obsessive-compulsive symptoms (OCS) associated with schizophrenia are an important clinical issue and markedly contribute to poor treatment outcomes in schizophrenia patients. Depending on the order of symptom onset, the course over time and the response to different treatment approaches, heterogeneous subgroups of comorbid patients can be defined. It was observed that certain second-generation antipsychotic agents (SGAs) may aggravate or even induce OCS as an unfavourable adverse event.

This chapter will summarize pharmacological strategies for the treatment of OCS in schizophrenia. In addition to optimizing antipsychotic monotherapy, several add-on procedures are described. They may either comprise the augmentation with non-antipsychotic substances or the combination with different antipsychotic agents. The latter strategy is particularly important for the management of SGA-induced OCS. In such cases, symptomatic improvement could be achieved by dose reductions of clozapine when combined with other SGAs such as aripiprazole.

The current level of evidence is limited by the lack of placebo- or comparator-controlled studies. Thus, the efficacy and tolerability of different pharmacological approaches will need to be compared to one another as well as to cognitive behavioural therapy in the future. As a next step, different strategies may be combined and tailored to the need of specific subgroups within the large sample of comorbid patients. Finally, multimodal treatment guidelines need to be established.

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Abbreviations

5HT:

5-Hydroxytryptamine, serotonin

AE:

Adverse event

AMS:

Amisulpride

APP:

Antipsychotic polypharmacy

APZ:

Aripiprazole

ARMS:

At-risk mental state

BD:

Bipolar disorder

BDNF:

Brain-derived neurotrophic factor

CBT:

Cognitive behavioural therapy

CLZ:

Clozapine

CR:

Case report

CS:

Case series

CSTC:

Cortico-striato-thalamo-cortical

DLGAP3:

Disks large-associated protein 3

ERP:

Exposure and response prevention

FGA:

First-generation antipsychotic

fMRI:

Functional magnetic resonance imaging

GxEI:

Gene and environment interaction

MS:

Mood stabilizers

NS:

Negative symptoms

OCD:

Obsessive-compulsive disorder

OCS:

Obsessive-compulsive symptoms

OLZ:

Olanzapine

PS:

Positive symptoms

QTP:

Quetiapine

SGA:

Second-generation antipsychotics

SLC1A1:

Solute carrier family gene 1A1

SNP:

Single-nucleotide polymorphism

SNRI:

Serotonin and noradrenaline reuptake inhibitor

SRI:

Serotonin reuptake inhibitor

SSRI:

Selective serotonin reuptake inhibitor

ZIPR:

Ziprasidone

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Conflicts of Interest

S.E. received travel research grants Lundbeck and Servier Pharmaceuticals.

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 Astra Zeneca, Lilly, Pfizer Pharma GmbH, Bristol Myers Squibb Pharmaceuticals, Roche, Servier, Otsuka, Janssen Cilag and Trommsdorff.

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  1. Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, 12 21 20, Mannheim, D-68072, Germany

    Susanne Englisch MD & Mathias Zink MD

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  1. Susanne Englisch MD
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  2. Mathias Zink MD
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Correspondence to Mathias Zink MD .

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  1. Dept. of Psychiatry, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands

    Lieuwe De Haan

  2. Department of Psychiatry, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands

    Frederike Schirmbeck

  3. Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany

    Mathias Zink

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Englisch, S., Zink, M. (2015). Polypharmacy for Obsessive-Compulsive Symptoms in Schizophrenia: Augmentation and Combination Strategies. 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_11

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