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No. 3 (2023)

PSYCHOPHARMACOTHERAPY

Obsessive-Compulsive Symptoms Induced by Clozapine Treatment (Management Algorithm)

https://doi.org/10.21265/PSYPH.2023.46.45.003

Published 2023-09-30

  • E.V. Andrienko
    • ,
  • E.S. Mosolova

E.V. Andrienko
Russian Medical Academy of Continuous Professional Education, Healthcare Ministry of the Ministry of Health of the Russian Federation

E.S. Mosolova
Federal State Budgetary Istitution Serbsky National Medical Research Centre for Psychiatry and Narcology of Ministry of Heath of the Russian Federation

Abstract

This review article aimed to study the relationship between the use of clozapine and the development of obsessive-compulsive symptoms (OCS) in patients with schizophrenia as well as to asesss potential management strategies. The review article analyzed the results of 11 cross-sectional, 5 retrospective studies, 3 reviews of cross-sectional and retrospective studies, 4 systematic reviews that included over 100 case reports with total sample over 2000 patients. The incidence of OCS in patients during clozapine treatment ranged from 20.6 to 76 % that is higher than in patients with schizophrenia (24 %), as well as in the general population (1–3 %). The development of OCS was associated with low (up to 250 mg/day) and high (over 350 mg/day) doses of clozapine. Clozapine’s antagonism to 5-HT2A and 5-HT2C receptors and high 5-HT2A/D2 occupancy ratio are considered to be possible pathogenetic mechanisms for clozapine induced OCS. Presumably, other mechanisms also underline the association between clozapine treatment and OCS development. According to analyzed literature data, clozapine dose modification, addition of aripiprazole, selective serotonin reuptake inhibitors (SSRIs), or clomipramine may be recommended for patients with clozapine-induced OCD, depending on its dosage and treatment duration. The relationship between OCS development and clozapine, as well as other mainly antiserotonergic second-generation antipsychotics (SGAs) certainly deserves attention and requires further investigation. This review article emphasizes the need for large randomized controlled trials dedicated to the management of SGAs-induced OCD.

Keywords

obsessive-compulsive disorder, obsessions, compulsions, clozapine, second-generation antipsychotics

PDF (Русский)

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