title: Suicidal Obsessions as Dose Dependent Side-Effect of Clozapine.
abstract: Although numerous reports suggest that different atypical antipsychotics can exacerbate or induce (de novo) obsessive-compulsive symptoms, there is no report of the development of ego-dystonic, suicidal obsessions during treatment with these medications. Here, the authors report the first case of clozapine-induced suicidal obsessions.
  The authors report a case of a patient diagnosed with bipolar disorder and who developed suicidal obsessions in the weeks after the dose of clozapine was increased from 150 mg/day to 300 mg/day.
  Symptoms quickly resolved after the treatment with clozapine was changed to the treatment with quetiapine and sodium valproate. Suicidal obsessions decreased promptly, within a few days, and disappeared completely when the dose of clozapine was 100 mg/day, quetiapine 600 mg/day, and sodium valproate 900 mg/day, 16 days after the initiation of changes in the medications.
  The case report emphasizes the crucial need of differentiation between genuine suicidal desires and ego-dystonic suicidal obsessions. The authors suggest that in similar cases a change in antipsychotic medications to those with stronger antidopaminergic properties and lower 5HT2 receptor affinity should be considered, but also assume that the use of sodium valproate in treatment of obsessive-compulsive symptoms deserves further study.
authors.affiliation: Dr. Aukst-Margetić, MD, PhD, Psychiatric Clinic, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia. Dr. Margetić, MD, Neuropsychiatric Hospital ˶Dr. Ivan Barbot", Jelengradska 1, Popovača, Croatia. Dr. Boričević Maršanić, MD, Psychiatric Hospital for Children and Youth, Kukuljevićeva 11, Zagreb, Croatia.
authors.forename: Branka
authors.initials: B
authors.lastname: Aukst-Margetić
authors.affiliation: Dr. Aukst-Margetić, MD, PhD, Psychiatric Clinic, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia. Dr. Margetić, MD, Neuropsychiatric Hospital ˶Dr. Ivan Barbot", Jelengradska 1, Popovača, Croatia. Dr. Boričević Maršanić, MD, Psychiatric Hospital for Children and Youth, Kukuljevićeva 11, Zagreb, Croatia.
authors.forename: Branimir
authors.initials: B
authors.lastname: Margetić
authors.affiliation: Dr. Aukst-Margetić, MD, PhD, Psychiatric Clinic, University Hospital Center Zagreb, Kišpatićeva 12, Zagreb, Croatia. Dr. Margetić, MD, Neuropsychiatric Hospital ˶Dr. Ivan Barbot", Jelengradska 1, Popovača, Croatia. Dr. Boričević Maršanić, MD, Psychiatric Hospital for Children and Youth, Kukuljevićeva 11, Zagreb, Croatia.
authors.forename: Vlatka
authors.initials: V
authors.lastname: Boričević Maršanić