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Effects of Antipsychotic Treatment on Obsessive-Compulsive Symptoms

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Obsessive-Compulsive Symptoms in Schizophrenia

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.

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Abbreviations

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

References

  • Achim AM, Maziade M, Raymond E, Olivier D, Merette C, Roy MA (2011) How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 37:811–821

    PubMed Central  PubMed  Google Scholar 

  • Angermeyer MC, Matschinger H, Schomerus G (2013) Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry 203:146–151

    PubMed  Google Scholar 

  • Aoyama F, Iida J, Inoue M, Iwasaka H, Sakiyama S, Hata K, Kishimoto T (2000) Brain imaging in childhood- and adolescence-onset schizophrenia associated with obsessive-compulsive symptoms. Acta Psychiatr Scand 102:32–37

    CAS  PubMed  Google Scholar 

  • Arnold PD, Sicard T, Burroughs E, Richter MA, Kennedy JL (2006) Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Arch Gen Psychiatry 63:769–776

    CAS  PubMed  Google Scholar 

  • Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Leucht S (2010) Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Syst Rev (11):CD006633

    Google Scholar 

  • Baker RW, Chengappa KN, Baird JW, Steingard S, Christ MA, Schooler NR (1992) Emergence of obsessive compulsive symptoms during treatment with clozapine. J Clin Psychiatry 53:439–442

    CAS  PubMed  Google Scholar 

  • Bandelow B, Zohar J, Hollander E, Kasper S, ller HJ; WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, Zohar J, Hollander E, Kasper S, ller HJ, Bandelow B, Allgulander C, yuso-Gutierrez J, Baldwin DS, Buenvicius R, Cassano G, Fineberg N, Gabriels L, Hindmarch I, Kaiya H, Klein DF, Lader M, Lecrubier Y, pine JP, Liebowitz MR, Lopez-Ibor JJ, Marazziti D, Miguel EC, Oh KS, Preter M, Rupprecht R, Sato M, Starcevic V, Stein DJ, van AM, Vega J (2008) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders – first revision. World J Biol Psychiatry 9:248–312

    Google Scholar 

  • Berman I, Kalinowski A, Berman SM, Lengua J, Green AI (1995a) Obsessive and compulsive symptoms in chronic schizophrenia. Compr Psychiatry 36:6–10

    CAS  PubMed  Google Scholar 

  • Berman I, Sapers BL, Chang HH, Losonczy MF, Schmildler J, Green AI (1995b) Treatment of obsessive-compulsive symptoms in schizophrenic patients with clomipramine. J Clin Psychopharmacol 15:206–210

    CAS  PubMed  Google Scholar 

  • Berman I, Merson A, Viegner B, Losonczy MF, Pappas D, Green AI (1998) Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study. J Nerv Ment Dis 186:150–156

    CAS  PubMed  Google Scholar 

  • Bienvenu OJ, Wang Y, Shugart YY, Welch JM, Grados MA, Fyer AJ, Rauch SL, McCracken JT, Rasmussen SA, Murphy DL, Cullen B, Valle D, Hoehn-Saric R, Greenberg BD, Pinto A, Knowles JA, Piacentini J, Pauls DL, Liang KY, Willour VL, Riddle M, Samuels JF, Feng G, Nestadt G (2009) Sapap3 and pathological grooming in humans: results from the OCD collaborative genetics study. Am J Med Genet B Neuropsychiatr Genet 150B:710–720

    CAS  PubMed  Google Scholar 

  • Bleich-Cohen M, Hendler T, Weizman R, Faragian S, Weizman A, Poyurovsky M (2014) Working memory dysfunction in schizophrenia patients with obsessive-compulsive symptoms: An fMRI study. Eur Psychiatry 29(3):160–166

    Google Scholar 

  • Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF (2006) A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry 11:622–632

    CAS  PubMed  Google Scholar 

  • Borkowska A, Pilaczynska E, Rybakowski JK (2013) The frontal lobe neuropsychological tests in patients with schizophrenia and/or obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci 15:359–362

    Google Scholar 

  • Bradford Hill A (2011) The environment and disease: association or causation? Bull World Health Organ 83:295–300

    Google Scholar 

  • Buckley PF, Miller BJ, Lehrer DS, Castle DJ (2009) Psychiatric comorbidities and schizophrenia. Schizophr Bull 35:383–402

    PubMed Central  PubMed  Google Scholar 

  • Bymaster FP, Rasmussen K, Calligaro DO, Nelson DL, DeLapp NW, Wong DT, Moore NA (1997) In vitro and in vivo biochemistry of olanzapine: a novel, atypical antipsychotic drug. J Clin Psychiatry 58(Suppl 10):28–36

    CAS  PubMed  Google Scholar 

  • Cai J, Zhang W, Lu W, Wu Z, Chen J, Yu S, Fang Y, Zhang C (2013) Influence of polymorphisms in genes SLC1A1, GRIN2B, and GRIK2 on clozapine-induced obsessive-compulsive symptoms. Psychopharmacology in 230(1):49–55

    Google Scholar 

  • Chang JS, Ahn Y-M, Park HJ, Lee KY, Kim SH, Kang UG, Kim JS (2008) Aripiprazole augmentation in clozapine-treated patients With refractory schizophrenia: an 8-week, randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 69:720–731

    CAS  PubMed  Google Scholar 

  • Correll CU (2008) Antipsychotic polypharmacy, part 2: why use 2 antipsychotics when 1 is not good enough? J Clin Psychiatry 69:860–861

    PubMed  Google Scholar 

  • Coward DM (1992) General pharmacology of clozapine. Br J Psychiatry Suppl 17:5–11

    Google Scholar 

  • Craig T, Hwang MY, Bromet EJ (2002) Obsessive-compulsive and panic symptoms in patients with first-admission psychosis. Am J Psychiatry 159:592–598

    PubMed  Google Scholar 

  • Cunill R, Huerta-Ramos E, Castells X (2013) The effect of obsessive-compulsive symptomatology on executive functions in schizophrenia: a systematic review and meta-analysis. Psychiatry Res 210:21–28. doi:10.1016/j.psychres.2013.05.029

    PubMed  Google Scholar 

  • de Haan L, Linszen DH, Gorsira R (1999) Clozapine and obsessions in patients with recent-onset schizophrenia and other psychotic disorders. J Clin Psychiatry 60:364–365

    PubMed  Google Scholar 

  • de Haan L, Beuk N, Hoogenboom B, Dingemans P, Linszen D (2002) Obsessive-compulsive symptoms during treatment with olanzapine and risperidone: a prospective study of 113 patients with recent-onset schizophrenia or related disorders. J Clin Psychiatry 63:104–107

    PubMed  Google Scholar 

  • de Haan L, Oekeneva A, van Amelsvoore T, Linszen D (2004) Obsessive-compulsive disorder and treatment with clozapine in 200 patients with recent-onset schizophrenia or related disorders. Eur Psychiatry 19:524

    PubMed  Google Scholar 

  • de Haan L, Sterk B, Wouters L, Linszen DH (2013) The 5-Year Course of Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder in First-Episode Schizophrenia and Related Disorders. Schizophr Bull 39:151–160

    Google Scholar 

  • Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee M, Himle JA, Leventhal BL, Cook EH Jr, Hanna GL (2006) Association testing of the positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-compulsive disorder. Arch Gen Psychiatry 63:778–785

    CAS  PubMed  Google Scholar 

  • Dold M, Aigner M, Lanzenberger R, Kasper S (2011) Efficacy of antipsychotic augmentation therapy in treatment-resistant obsessive-compulsive disorder – a meta-analysis of double-blind, randomised, placebo-controlled trials. Fortschr Neurol Psychiatr 79:453–466

    CAS  PubMed  Google Scholar 

  • Doyle M, Chorcorain AN, Griffith E, Trimble T, OGÇÖCallaghan E (2014) Obsessive compulsive symptoms in patients with schizophrenia on clozapine and with obsessive compulsive disorder: a comparison study. Compr Psychiatry 55:130–136

    PubMed  Google Scholar 

  • Duggan L, Fenton M, Dardennes RM, El-Dosoky A, Indran S (2000) Olanzapine for schizophrenia. Cochrane Database Syst Rev [computer file]: CD001359

    Google Scholar 

  • Englisch S, Zink M (2008) Combined antipsychotic treatment involving clozapine and aripiprazole. Prog Neuropsychopharmacol Biol Psychiatry 32:1386–1392

    CAS  PubMed  Google Scholar 

  • Englisch S, Esslinger C, Inta D, Weinbrenner A, Peus V, Gutschalk A, Schirmbeck F, Zink M (2009) Clozapine-induced obsessive compulsive syndromes improve in combination with aripiprazole. Clin Neuropharmacol 32:227–229

    CAS  PubMed  Google Scholar 

  • Ertugrul A, nil Yagcioglu AE, Eni N, Yazici KM (2005) Obsessive-compulsive symptoms in clozapine-treated schizophrenic patients. Psychiatry Clin Neurosci 59:219–222

    PubMed  Google Scholar 

  • Eryilmaz G, Sayar GH, Ozten E, Gögcegöz I, Karamustafalioglu O (2013) Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia. Ann Gen Psychiatry 12:40

    PubMed Central  PubMed  Google Scholar 

  • Fenton WS, McGlashan TH (1986) The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry 143:437–441

    CAS  PubMed  Google Scholar 

  • Friedlander L, Desrocher M (2006) Neuroimaging studies of obsessive-compulsive disorder in adults and children. Clin Psychol Rev 26:32–49

    PubMed  Google Scholar 

  • Grados MA, Specht MW, Sung HM, Fortune D (2013) Glutamate drugs and pharmacogenetics of OCD: a pathway-based exploratory approach. Expert Opin Drug Discov. doi:10.1517/17460441.2013.845553, 1–13

    PubMed  Google Scholar 

  • Graybiel AM, Rauch SL (2000) Toward a neurobiology of obsessive-compulsive disorder. Neuron 28:343–347

    CAS  PubMed  Google Scholar 

  • Gregory A, Lau J, Eley T (2008) Finding gene-environment interactions for generalised anxiety disorder. Eur Arch Psychiatry Clin Neurosci 258:69–75

    PubMed  Google Scholar 

  • Gupta S, Daniel DG (1995) Cautions in the clozapine-to-risperidone switch. Ann Clin Psychiatry 7:149

    CAS  PubMed  Google Scholar 

  • Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Thibaut F, M+Âller HJ (2012) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J Biol Psychiatry 14:2–44

    PubMed  Google Scholar 

  • Hashim HM, Fawzy N, Fawzi MM, Karam RA (2012) Brain-derived neurotrophic factor Val66Met polymorphism and obsessive-compulsive symptoms in Egyptian schizophrenia patients. J Psychiatr Res. http://dx.doi.org/10.1016/j.jpsychires.2012.03.007

  • Hermesh H, Weizman A, Gur S, Zalsman G, Shiloh R, Zohar J, Gross-Isseroff R (2003) Alternation learning in OCD/schizophrenia patients. Eur Neuropsychopharmacol 13:87–91

    CAS  PubMed  Google Scholar 

  • Hippius H (1989) The history of clozapine. Psychopharmacology (Berl) 99(Suppl):S3–S5

    Google Scholar 

  • Howes OD, Kambeitz J, Kim E, Stahl D, Slifstein M, bi-Dargham A, Kapur S (2012) The nature of dopamine dysfunction in schizophrenia and what this means for treatment: a meta-analysis of imaging studies. Arch Gen Psychiatry 69:776–786

    PubMed Central  CAS  PubMed  Google Scholar 

  • Hwang MY, Morgan JE, Losconzcy MF (2000) Clinical and neuropsychological profiles of obsessive-compulsive schizophrenia: a pilot study.[see comment]. J Neuropsychiatry Clin Neurosci 12:91–94

    CAS  PubMed  Google Scholar 

  • Insel TR (2010) Rethinking schizophrenia. Nature 468:187–193

    CAS  PubMed  Google Scholar 

  • Insel TR, Scolnick EM (2006) Cure therapeutics and strategic prevention: raising the bar for mental health research. Mol Psychiatry 11:11–17

    PubMed Central  CAS  PubMed  Google Scholar 

  • Jakob H, Beckmann H (1986) Prenatal developmental disturbances in the limbic allocortex in schizophrenics. J Neural Transm 65:303–326

    CAS  PubMed  Google Scholar 

  • Jakob H, Beckmann H (1989) Gross and histological criteria for developmental disorders in brains of schizophrenics. J R Soc Med 82:466–469

    PubMed Central  CAS  PubMed  Google Scholar 

  • Joel D (2006) Current animal models of obsessive compulsive disorder: a critical review. Prog Neuropsychopharmacol Biol Psychiatry 30:374–388

    PubMed  Google Scholar 

  • Joober R, Boksa P (2010) Clozapine: a distinct, poorly understood and under-used molecule. J Psychiatry Neurosci 35:147–149

    PubMed Central  PubMed  Google Scholar 

  • Kane JM (2011) A user’s guide to clozapine. Acta Psychiatr Scand 123:407–408

    PubMed  Google Scholar 

  • Kane J, Honigfeld G, Singer J, Meltzer H (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45:789–796

    CAS  PubMed  Google Scholar 

  • Kang X, Simpson GM (2010) Clozapine: more side effects but still the best antipsychotic. J Clin Psychiatry 71:982–983

    PubMed  Google Scholar 

  • Kantrowitz J, Javitt DC (2013) Glutamatergic transmission in schizophrenia: from basic research to clinical practice. Curr Opin Psychiatry 25:96–102

    Google Scholar 

  • Karch S, Pogarell O (2011) Neurobiologie der Zwangsstörung. Nervenarzt 82:299–307

    CAS  PubMed  Google Scholar 

  • Keers R, Uher R (2012) Gene-environment interaction in major depression and antidepressant treatment response. Curr Psychiatry Rep 14:129–137

    PubMed  Google Scholar 

  • Kelly DL, Richardson CM, Tamminga CA, Carpenter WT (2003) The efficacy of high-dose olanzapine versus clozapine in treatment-resistant schizophrenia: a double-blind, crossover study. J Clin Psychopharmacol 23:668–670

    PubMed  Google Scholar 

  • Kim SW, Shin IS, Kim JM, Yang SJ, Hwang MY, Yoon JS (2008) Amisulpride improves obsessive-compulsive symptoms in schizophrenia patients taking atypical antipsychotics: an open-label switch study. J Clin Psychopharmacol 28:349–352

    PubMed  Google Scholar 

  • Kim JH, Ryu S, Nam HJ, Lim M, Baek JH, Joo YH, Kwon JS, Ha TH, Hong KS (2012) Symptom structure of antipsychotic-induced obsessive compulsive symptoms in schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 39:75–79

    CAS  PubMed  Google Scholar 

  • Kordon A, Zurowski B, Wahl K, Hohagen F (2011) Evidence-based pharmacotherapy and other somatic treatment approaches for obsessive-compulsive disorder: state of the art. Nervenarzt 82:319–320

    CAS  PubMed  Google Scholar 

  • Krause DL, Matz J, Schennach R, Mueller N, Dehning S (2013) Ziprasidone for obsessive compulsive disorder in schizophrenia. Ther Adv Psychopharmacol 3:115–116

    PubMed Central  PubMed  Google Scholar 

  • Kuelz AK, Hohagen F, Voderholzer U (2004) Neuropsychological performance in obsessive-compulsive disorder: a critical review. [Review] [108 refs]. Biol Psychol 65:185–236

    PubMed  Google Scholar 

  • Kulkarni G, Narayanaswamy JC, Math SB (2012) Olanzapine induced de-novo obsessive compulsive disorder in a patient with schizophrenia. Indian J Pharmacol 44:649–650

    PubMed Central  PubMed  Google Scholar 

  • Kumbhani SR, Roth RM, Kruck CL, Flashman LA, McAllister TW (2010) Nonclinical obsessive-compulsive symptoms and executive functions in schizophrenia. J Neuropsychiatry Clin Neurosci 22:304–312

    PubMed Central  PubMed  Google Scholar 

  • Kwon JS, Joo YH, Nam HJ, Lim M, Cho EY, Jung MH, Choi JS, Kim B, Kang DH, Oh S, Park T, Hong KS (2009) Association of the glutamate transporter gene SLC1A1 with atypical antipsychotics-induced obsessive-compulsive symptoms. Arch Gen Psychiatry 66:1233–1241

    CAS  PubMed  Google Scholar 

  • Lee M-J, Shin Y-B, Sunwoo Y-K, Jung S-H, Kim W-H, Kang M-H, Lee J-S, Bae J-M, Kim C-E (2009) Comparative analysis of cognitive function in schizophrenia with and without obsessive compulsive disorder. Psychiatry Investig 6:286–293

    PubMed Central  PubMed  Google Scholar 

  • Leucht S, Hierl S, Kissling W, Dold M, Davis JM (2012a) Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry 200:97–106

    PubMed  Google Scholar 

  • Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM (2012b) Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 379:2063–2071

    CAS  PubMed  Google Scholar 

  • Levine JB, Gruber SA, Baird AA, Yurgelun-Todd D (1998) Obsessive-compulsive disorder among schizophrenic patients: an exploratory study using functional magnetic resonance imaging data. Compr Psychiatry 39:308–311

    CAS  PubMed  Google Scholar 

  • Lim M, Park DY, Kwon JS, Joo YH, Hong KS (2007) Prevalence and clinical characteristics of obsessive-compulsive symptoms associated with atypical antipsychotics. J Clin Psychopharmacol 27:712–713

    CAS  PubMed  Google Scholar 

  • Lin SK, Su SF, Pan CH (2006) Higher plasma drug concentration in clozapine-treated schizophrenic patients with side effects of obsessive/compulsive symptoms. Ther Drug Monit 28:303–307

    CAS  PubMed  Google Scholar 

  • Linden DE (2006) How psychotherapy changes the brain – the contribution of functional neuroimaging. Mol Psychiatry 11:528–538

    CAS  PubMed  Google Scholar 

  • Lopez-Gil X, Artigas F, Adell A (2010) Unraveling monoamine receptors involved in the action of typical and atypical antipsychotics on glutamatergic and serotonergic transmission in prefrontal cortex. Curr Pharm Des 16:502–515

    CAS  PubMed  Google Scholar 

  • Lykouras L, Alevizos B, Michalopoulou P, Rabavilas A (2003) Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry 27:333–346

    PubMed  Google Scholar 

  • Lysaker PH, Whitney KA (2009) Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment. Expert Rev Neurother 9:99–107

    PubMed  Google Scholar 

  • Lysaker PH, Bryson GJ, Marks KA, Greig TC, Bell MD (2002) Association of obsessions and compulsions in schizophrenia with neurocognition and negative symptoms. J Neuropsychiatry Clin Neurosci 14:449–453

    PubMed  Google Scholar 

  • Lysaker PH, Whitney KA, Davis LW (2009) Associations of executive function with concurrent and prospective reports of obsessive-compulsive symptoms in schizophrenia. J Neuropsychiatry Clin Neurosci 21:38–42

    PubMed  Google Scholar 

  • McDougle CJ, Barr LC, Goodman WK, Pelton GH, Aronson SC, Anand A, Price LH (1995) Lack of efficacy of clozapine monotherapy in refractory obsessive-compulsive disorder. Am J Psychiatry 152:1812–1814

    CAS  PubMed  Google Scholar 

  • McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RS, Davis CE, Severe J, Hsiao JK, CATIE I, McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, Swartz MS, Perkins DO, Keefe RSE, Davis CE, Severe J, Hsiao JK, CATIE I (2006) Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. [see comment]. Am J Psychiatry 163:600–610

    PubMed  Google Scholar 

  • Meijer JHM, Swets MM, Keeman SM, Nieman DHP, Meijer CJP, GROUP Investigators (2013) Is a schizo-obsessive subtype associated with cognitive impairment?: results from a large cross-sectional study in patients with psychosis and their unaffected relatives. J Nerv Ment Dis 201:30–35

    PubMed  Google Scholar 

  • Meltzer HY (1994) An overview of the mechanism of action of clozapine. J Clin Psychiatry 55(Suppl B):47–52

    PubMed  Google Scholar 

  • Meltzer HY (2012) Clozapine. Clin Schizophr Relat Psychoses 6:134–144

    PubMed  Google Scholar 

  • Meltzer HY, Huang M (2008) In vivo actions of atypical antipsychotic drug on serotonergic and dopaminergic systems. Prog Brain Res 172:177–197

    CAS  PubMed  Google Scholar 

  • Meltzer HY, Sumiyoshi T (2008) Does stimulation of 5-HT(1A) receptors improve cognition in schizophrenia? Behav Brain Res 195:98–102

    CAS  PubMed  Google Scholar 

  • Meltzer HY, Li Z, Kaneda Y, Ichikawa J (2003) Serotonin receptors: their key role in drugs to treat schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 27:1159–1172

    CAS  PubMed  Google Scholar 

  • Michalopoulou PG, Konstantakopoulos G, Typaldou M, Papageorgiou C, Christodoulou GN, Lykouras L, Oulis P (2014) Can cognitive deficits differentiate between schizophrenia with and without obsessive-compulsive symptoms? Compr Psychiatry. doi:10.1016/j.comppsych.2013.12.004

    PubMed  Google Scholar 

  • Mukhopadhaya K, Krishnaiah R, Taye T, Nigam A, Bailey AJ, Sivakumaran T, Fineberg NA (2009) Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause for clinical concern. J Psychopharmacol 23:6–13

    CAS  PubMed  Google Scholar 

  • Muscatello MR, Bruno A, Pandolfo G, Mico U, Scimeca G, Romeo VM, Santoro V, Settineri S, Spina E, Zoccali RA (2011) Effect of aripiprazole augmentation of serotonin reuptake inhibitors or clomipramine in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. J Clin Psychopharmacol 31:174–179

    CAS  PubMed  Google Scholar 

  • Nakao T, Nakagawa A, Yoshiura T, Nakatani E, Nabeyama M, Yoshizato C, Kudoh A, Tada K, Yoshioka K, Kawamoto M, Togao O, Kanba S (2005) Brain activation of patients with obsessive – compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study. Biol Psychiatry 57:901–910

    PubMed  Google Scholar 

  • Nicolini H, Arnold P, Nestadt G, Lanzagorta N, Kennedy JL (2009) Overview of genetics and obsessive-compulsive disorder. Psychiatry Res 170:7–14

    CAS  PubMed  Google Scholar 

  • Nolfe G, Milano W, Zontini G, Petrella C, De RM, Rundle-Smith S, Nolfe G (2010) Obsessive-compulsive symptoms in schizophrenia: their relationship with clinical features and pharmacological treatment. J Psychiatr Pract 16:235–242

    PubMed  Google Scholar 

  • Nugent N, Tyrka A, Carpenter L, Price L (2011) Gene-environment interactions: early life stress and risk for depressive and anxiety disorders. Psychopharmacology (Berl) 214:175–196

    CAS  Google Scholar 

  • Öngür D, Goff DC (2005) Obsessive-compulsive symptoms in schizophrenia: associated clinical features, cognitive function and medication status. Schizophr Res 75:349–362

    PubMed  Google Scholar 

  • Pani L, Villagran JM, Kontaxakis VP, Alptekin K (2008) Practical issues with amisulpride in the management of patients with schizophrenia. Clin Drug Investig 28:465–477

    CAS  PubMed  Google Scholar 

  • Patel DD, Laws KR, Padhi A, Farrow JM, Mukhopadhaya K, Krishnaiah R, Fineberg NA (2010) The neuropsychology of the schizo-obsessive subtype of schizophrenia: a new analysis. Psychol Med 40:921–933

    CAS  PubMed  Google Scholar 

  • Pauls DL (2010) The genetics of obsessive-compulsive disorder: a review. Dialogues Clin Neurosci 12:149–163

    PubMed Central  PubMed  Google Scholar 

  • Peselmann N, Schmitt A, Gebicke-Haerter P, Zink M (2012) Aripiprazole differentially regulates the expression of Gad67 and ã-amino-butyric acid transporters in rat brain. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-012-0367-y

    PubMed  Google Scholar 

  • Peters B, de Haan L (2009) Remission of schizophrenia psychosis and strong reduction of obsessive-compulsive disorder after adding clozapine to aripiprazole. Prog Neuropsychopharmacol Biol Psychiatry 33:1576–1577

    CAS  PubMed  Google Scholar 

  • Pogarell O, Hamann C, Poepperl G, Juckel G, Chouker M, Zaudig M, Riedel M, Moeller HJ, Hegerl U, Tatsch K (2003) Elevated brain serotonin transporter availability in patients with obsessive-compulsive disorder. Biol Psychiatry 54:1406–1413

    CAS  PubMed  Google Scholar 

  • Porton B, Greenberg BD, Askland K, Serra LM, Gesmonde J, Rudnick G, Rasmussen SA, Kao HT (2013) Isoforms of the neuronal glutamate transporter gene, SLC1A1/EAAC1, negatively modulate glutamate uptake: relevance to obsessive-compulsive disorder. Transl Psychiatry. doi:10.1038/tp.2013.35, e259

    PubMed Central  PubMed  Google Scholar 

  • Poyurovsky M (2013) Schizo-obsessive disorder. Cambridge university press 1:1–245

    Google Scholar 

  • Poyurovsky M, Isakov V, Hromnikov S, Modai I, Rauchberger B, Schneidman M, Weizman A (1999) Fluvoxamine treatment of obsessive-compulsive symptoms in schizophrenic patients: an add-on open study. Int Clin Psychopharmacol 14:95–100

    CAS  PubMed  Google Scholar 

  • Poyurovsky M, Weizman A, Weizman R (2004) Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs 18:989–1010

    CAS  PubMed  Google Scholar 

  • Poyurovsky M, Glick I, Koran LM (2010) Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms. J Psychopharmacol 24:861–866

    CAS  PubMed  Google Scholar 

  • Readler TJ, Knable MB, Weinberger DR (1998) Schizophrenia as a developmental disorder of the cerebral cortex. Curr Opin Neurobiol 8:157–161

    Google Scholar 

  • Remington G (2008) Alterations of dopamine and serotonin transmission in schizophrenia. Prog Brain Res 172:117–140

    CAS  PubMed  Google Scholar 

  • Remington G, Agid O, Foussias G, Hahn M, Rao N, Sinyor M (2013) Clozapines role in the treatment of first-episode schizophrenia. Am J Psychiatry 170:146–151

    PubMed  Google Scholar 

  • Reznik I, Yavin I, Stryjer R, Spivak B, Gonen N, Strous R, Mester R, Weizman A, Kotler M (2004) Clozapine in the treatment of obsessive-compulsive symptoms in schizophrenia patients: a case series study. Pharmacopsychiatry 37:52–56

    CAS  PubMed  Google Scholar 

  • Rocha FL, Hara C (2006) Benefits of combining aripiprazole to clozapine: Three case reports. Prog Neuropsychopharmacol Biol Psychiatry 30:1167–1169

    CAS  PubMed  Google Scholar 

  • Ryu S, Oh S, Cho EY, Nam HJ, Yoo JH, Park T, Joo YH, Kwon JS, Hong KS (2011) Interaction between genetic variants of DLGAP3 and SLC1A1 affecting the risk of atypical antipsychotics-induced obsessive-compulsive symptoms. Am J Med Genet B Neuropsychiatr Genet 156:949–959

    CAS  Google Scholar 

  • Sa AR, Hounie AG, Sampaio AS, Arrais J, Miguel EC, Elkis H (2009) Obsessive-compulsive symptoms and disorder in patients with schizophrenia treated with clozapine or haloperidol. Compr Psychiatry 50:437–442

    PubMed  Google Scholar 

  • Saxena S, BRODY AL, SCHWARTZ JM, Baxter LR (1998) Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry 173:26–37

    Google Scholar 

  • Saxena S, Brody AL, Maidment KM, Dunkin JJ, Colgan M, Alborzian S, Phelps ME, Baxter LRJ (1999) Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessive-compulsive disorder. Neuropsychopharmacology 21:683–693

    CAS  PubMed  Google Scholar 

  • Saxena S, Gorbis E, O’Neill J, Baker SK, Mandelkern MA, Maidment KM, Chang S, Salamon N, BRODY AL, SCHWARTZ JM, London ED (2009) Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder. Mol Psychiatry 14:197

    PubMed Central  CAS  PubMed  Google Scholar 

  • Scatton B, Claustre Y, Cudennec A, Oblin A, Perrault G, Sanger DJ, Schoemaker H (1997) Amisulpride: from animal pharmacology to therapeutic action. Int Clin Psychopharmacol 12(Suppl 2):S29–S36

    PubMed  Google Scholar 

  • Scheltema Beduin AA, Sweets M, Machielsen M, Korver N, GROUP Consortium (2012) Obsessive-compulsive symptoms in patients with schizophrenia comparing treatment with clozapine, olanzapine, risperidone and no antipsychotics: a naturalistic cross-sectional study of 543 patients. J Clin Psychiatry 73:1395–1402

    PubMed  Google Scholar 

  • Schirmbeck F, Zink M (2012) Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review. Curr Neuropharmacol 10:88–95

    PubMed Central  CAS  PubMed  Google Scholar 

  • Schirmbeck F, Zink M (2013a) The cognitive behavioural therapist. The Cognitive Behaviour Therapist 6:1–13. http://dx.doi.org/10.1017/S1754470X13000123

  • Schirmbeck F, Zink M (2013b) Frontiers in neuropharmacology. Front Pharmacol 4:1–99.doi:10.3389/fphar.2013.00099

  • Schirmbeck F, Esslinger C, Rausch F, Englisch S, Meyer-Lindenberg A, Zink M (2011) Antiserotonergic antipsychotics are associated with obsessive-compulsive symptoms in schizophrenia. Psychol Med 41:2361–2374

    CAS  PubMed  Google Scholar 

  • Schirmbeck F, Nieratschker V, Frank J, Englisch S, Rausch F, Meyer-Lindenberg A, Rietschel M, Zink M (2012a) Polymorphisms in the glutamate transporter gene SLC1A1 and obsessive compulsive symptoms induced by second generation antipsychotic agents. Psychiatr Genet 22:245–252

    CAS  PubMed  Google Scholar 

  • Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M (2012b) Stable cognitive deficits in schizophrenia patients with comorbid obsessive-compulsive symptoms: a 12 months longitudinal study. Schizophr Bull 6:1261–1271. doi:10.1093/schbul/sbs123

  • Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M (2013) Differential effects of antipsychotic agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol 27:349–357

    CAS  PubMed  Google Scholar 

  • Schirmbeck F, Mier D, Esslinger C, Rausch F, Englisch S, Eifler S, Meyer-Lindenberg A, Kirsch P, Zink M (2014) Increased orbitofrontal cortex activation during treatment with pro-obsessive antipsychotic drugs. J Psychiatry Neurosci. doi: 10.1503/jpn.140021

  • Shapiro DA, Renock S, Arrington E, Chiodo LA, Liu LX, Sibley DR, Roth BL, Mailman R (2003) Aripiprazole, a novel atypical antipsychotic drug with a unique and robust pharmacology. Neuropsychopharmacology 28:1400–1411

    CAS  PubMed  Google Scholar 

  • Shugart YY, Wang Y, Samuels JF, Grados MA, Greenberg BD, Knowles JA, McCracken JT, Rauch SL, Murphy DL, Rasmussen SA, Cullen B, Hoehn-Saric R, Pinto A, Fyer AJ, Piacentini J, Pauls DL, Bienvenu OJ, Riddle MA, Liang KY, Nestadt G (2009) A family-based association study of the glutamate transporter gene SLC1A1 in obsessive-compulsive disorder in 378 families. Am J Med Genet B Neuropsychiatr Genet 150B:886–892

    CAS  PubMed  Google Scholar 

  • Sparshatt A, Taylor D, Patel MX, Kapur S (2010) A systematic review of aripiprazole–dose, plasma concentration, receptor occupancy, and response: implications for therapeutic drug monitoring. J Clin Psychiatry 71:1447–1456

    CAS  PubMed  Google Scholar 

  • Stan A, Lewis D (2012) Altered cortical GABA neurotransmission in schizophrenia: insights into novel therapeutic strategies. Curr Pharm Biotechnol 13:1557–1562

    PubMed Central  CAS  PubMed  Google Scholar 

  • Starck G, Ljungberg M, Nilsson M, Jonsson L, Lundberg S, Ivarsson T, Ribbelin S, Ekholm S, Carlsson A, Forssell-Aronsson E, Carlsson ML (2008) A 1H magnetic resonance spectroscopy study in adults with obsessive compulsive disorder: relationship between metabolite concentrations and symptom severity. J Neural Transm 115:1051–1062

    PubMed  Google Scholar 

  • Steingard S, Chengappa KNR, Baker R, Schooler NR (1993) Clozapine, obsessive symptoms, and serotonergic mechanisms. Am J Psychiatry 150:1435

    CAS  PubMed  Google Scholar 

  • Stewart SE, Fagerness JA, Platko J, Smoller JW, Scharf JM, Illmann C, Jenike E, Chabane N, Leboyer M, Delorme R, Jenike MA, Pauls DL (2007) Association of the SLC1A1 glutamate transporter gene and obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet 144 B:1027–1033

    Google Scholar 

  • Still DJ, Dorson PG, Crismon ML, Pousson C (1996) Effects of switching inpatients with treatment-resistant schizophrenia from clozapine to risperidone. Psychiatr Serv 47:1382–1384

    CAS  PubMed  Google Scholar 

  • Strakowski SM, Tohen M, Stoll AL, Faedda GL, Mayer PV, Kolbrener ML, Goodwin DC (1993) Comorbidity in psychosis at first hospitalization. Am J Psychiatry 150:752–757

    CAS  PubMed  Google Scholar 

  • Strakowski SM, Keck PE Jr, McElroy SL, Lonczak HS, West SA (1995) Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry 36:106–112

    CAS  PubMed  Google Scholar 

  • Stryjer R, Dambinsky Y, Timinsky I, Green T, Kotler M, Weizman A, Spivak B (2012) Escitalopram in the treatment of patients with schizophrenia and obsessive-compulsive disorder: an open-label, prospective study. [Article]. Int Clin Psychopharmacol. doi:10.1097/YIC.0b013e32835bd24e

    Google Scholar 

  • Swets M, Dekker J, van Emmerik-van Oortmerssen K, Smid GE, Smit F, de Haan L, Schoevers RA (2013) The obsessive compulsive spectrum in schizophrenia, a meta-analysis and meta-regression exploring prevalence rates. Schizophr Res. http://dx.doi.org/10.1016/j.schres.2013.10.033

  • Tiihonen J, Lonnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, Haukka J (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study).[see comment]. Lancet 374:620–627

    PubMed  Google Scholar 

  • Tiryaki A, Ozkorumak E (2010) Do the obsessive-compulsive symptoms have an effect in schizophrenia? Compr Psychiatry 51:357–362

    PubMed  Google Scholar 

  • Tumkaya S, Karadag F, Oguzhanoglu NK, Tekkanat C, Varma G, Ozdel O, Atesci F (2009) Schizophrenia with obsessive-compulsive disorder and obsessive-compulsive disorder with poor insight: a neuropsychological comparison. Psychiatry Res 165:38–46

    PubMed  Google Scholar 

  • Tundo A, Salvati L, Di Spigno D, Cieri L, Parena A, Necci R, Sciortino S (2012) Cognitive-behavioral therapy for obsessive-compulsive disorder as a comorbidity with schizophrenia or schizoaffective disorder. Psychother Psychosom 81:58–60

    PubMed  Google Scholar 

  • Tundo A, Salvati L, Cieri L, Daniele M, Di Spigno D, Necci R, Parena A (2014) Effectiveness and outcome predictors of cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis. J Psychopathol 20:127–133

    Google Scholar 

  • Van der Wee NJ, Stevens H, Hardeman JA, Mandl RC, Denys DA, van Megen HJ, Kahn RS, Westenberg HM (2004) Enhanced Dopamine Transporter Density in Psychotropic-Naive Patients With Obsessive-Compulsive Disorder Shown by [123I]ß-CIT SPECT. Am J Psych 161:2201–2206.

    Google Scholar 

  • van Nimwegen L, de Haan L, van Beveren N, Laan W, van den Brink W, Linszen D (2008) Obsessive-compulsive symptoms in a randomized, double-blind study with olanzapine or risperidone in young patients with early psychosis. J Clin Psychopharmacol 28:214–218

    PubMed  Google Scholar 

  • van Os J, Kapur S (2009) Schizophrenia. Lancet 374:635–645

    PubMed  Google Scholar 

  • van Os J, Rutten BP, Poulton R (2008) Gene-environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophr Bull 34:1066–1082

    PubMed Central  PubMed  Google Scholar 

  • van Os J, Kenis G, Rutten BP (2010) The environment and schizophrenia. Nature 468:203–212

    PubMed  Google Scholar 

  • Veenstra-VanderWeele J, Kim SJ, Gonen D, Hanna GL, Leventhal BL, Cook EH Jr (2001) Genomic organization of the SLC1A1/EAAC1 gene and mutation screening in early-onset obsessive-compulsive disorder. Mol Psychiatry 6:160–167

    CAS  PubMed  Google Scholar 

  • Villari V, Frieri T, Fagiolini A (2011) Aripiprazole augmentation in clozapine-associated obsessive-compulsive symptoms. J Clin Psychopharmacol 31:375–376

    PubMed  Google Scholar 

  • Wendland JR, Moya PR, Timpano KR, Anavitarte AP, Kruse MR, Wheaton MG, Ren-Patterson RF, Murphy DL (2009) A haplotype containing quantitative trait loci for SLC1A1 gene expression and its association with obsessive-compulsive disorder. Arch Gen Psychiatry 66:408–416

    PubMed Central  CAS  PubMed  Google Scholar 

  • Whiteside SP, Port JD, Abramowitz JS (2004) A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res 132:69–79

    PubMed  Google Scholar 

  • Whiteside SP, Port JD, Deacon BJ, Abramowitz JS (2006) A magnetic resonance spectroscopy investigation of obsessive-compulsive disorder and anxiety. Psychiatry Res 146:137–147

    PubMed  Google Scholar 

  • Whitney KA, Fastenau PS, Evans JD, Lysaker PH (2004) Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms. Schizophr Res 69:75–83

    PubMed  Google Scholar 

  • Zink M (2007) Plasticity of brain development as a perspective of basic science in psychiatry. Shaker Verlag – Online Publication, doi:10.2370/210_194

  • Zink M (2014), Comorbid obsessive-compulsive symptoms in schizophrenia: insight into pathomechanisms facilitates treatment. Advances in Medicine, in press

    Google Scholar 

  • Zink M, Knopf U, Kuwilsky A (2006) Management of clozapine-induced obsessive compulsive symptoms in a man with schizophrenia. Aust N Z J Psychiatry 41:293–294

    Google Scholar 

  • Zink M, Englisch S, Knopf U, Kuwilsky A, Dressing H (2007) Augmentation of clozapine with valproic acid for clozapine-induced obsessive compulsive symptoms. Pharmacopsychiatry 40:202–203

    CAS  PubMed  Google Scholar 

  • Zink M, Schirmbeck F, Rausch F, Eifler S, Elkin H, Solojenkina X, Englisch S, Wagner M, Maier W, Lautenschlager M, Heinz A, Gudlowski Y, Janssen B, Gaebel W, Michel TM, Schneider F, Lambert M, Naber D, Juckel G, Krueger-Oezguerdal S, Wobrock T, Hasan A, Riedel M, Müller H, Klosterkotter J, Bechdolf A (2014a) Obsessive-compulsive symptoms in at-risk mental states for psychosis are associated with more severe clinical impairment but less cognitive dysfunctions. Acta Psychiatr Scand 130(3):214–226

    Google Scholar 

  • Zink M, Englisch S, Schmitt A (2014b) Antipsychotic treatment modulates glutamate transport and NMDA receptor expression. Eur Arc Psychiatry Clin Neurosci Suppl 1:S67–S82

    Google Scholar 

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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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  1. Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands

    Frederike Schirmbeck PhD

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

    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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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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