title: Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre.
abstract: OBJECTIVE
  To study the prevalence, phenomenology and course of OCS/OCD in patients receiving clozapine.
  
  
  METHODS
  Case records of 220 patients who received clozapine for at least 3 months were reviewed.
  
  
  RESULTS
  One fifth (N=42; 19.1%) of patients had OCS/OCD, of which majority (13.2%) had onset of OCS/OCD prior to starting of clozapine and remaining 5.9% developed OCS/OCD after starting of clozapine. About one fourth of the patients with pre-existing OCS/OCD had worsening with clozapine while the remaining maintained at the same level (55.17%) or improved (20.7%). Majority of the patients who developed de novo OCS/OCD on clozapine were females and OCS/OCD emerged within 12 months (69.2%) of starting of clozapine. In those who developed OCS/OCD with clozapine, among obsessions, pathological doubts were most common, followed by obsessions with sexual content; among compulsions repetitive checking was the most common. SSRIs were required for management in half the patients, while the remaining improved spontaneously or with reduction in clozapine dose.
  
  
  CONCLUSIONS
  Clozapine can lead to aggravation or de novo presentation of OCS/OCD but these can be managed with reduction in dose or addition of SSRIs.
authors.affiliation: Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address: drsandeepg2002@yahoo.com.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Grover
authors.affiliation: Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Nandita
authors.initials: N
authors.lastname: Hazari
authors.affiliation: Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Subho
authors.initials: S
authors.lastname: Chakrabarti
authors.affiliation: Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Avasthi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000139:chemically induced*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Clozapine; Compulsions; Obsessions; Obsessive compulsive disorder