Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses.
The prevalence of OCS and OCD is higher in schizophrenic patients than in the general population. These disorders are sometimes induced by AAPs. There is higher frequency of OCS and greater severity in patients treated with antipsychotics with predominant anti-serotoninergic profiles opposed to those with predominant dopaminergic blockade. Induced OCS may be due to complex neuromodulation involving many serotonin, dopamine and glutamate receptors and several subtypes. Concerning connectivity, AAPs differentially influence the BOLD signal, depending on the intensity of D2 receptor blockade. The OFC could play a significant role, on account of its involvement in inhibitory control. There is a paradox: AAPs are efficient as augmentation to SSRI in treatment resistant OCD, some of them such as risperidone or aripiprazole have favourable effects in schizoptypic OCD, but AAPs cause induced OCS in schizophrenic patients. When prescribing AAPs, we should inform patients about this potential side effect and assess systematically OCS with Y-BOCS assessment after 1 month of treatment. Afterwards there are different strategies: Aripiprazole in combination can reduce OCS induced by clozapine, SSRI are slightly effective and CBT shows a few encouraging results. OCS are sometimes dose-dependent, so we also recommend prescribing the minimum effective dose and gradual introduction.
Hôpital Universitaire Paul Brousse, Service de Psychiatrie et Addictologie, 12 avenue Paul Vaillant-Couturier, 94800 Villejuif, France; UnitéINSERM 1178, Hôpital Universitaire Paul Brousse, France. Electronic address: dianegl@hotmail.fr.
Diane
D
Grillault Laroche
Hôpital Sainte-Anne, Service Hopitalo-Universitaire, 1, rue Cabanis, 75014 Paris, France.
Adeline
A
Gaillard
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000139:chemically induced* / Q000453:epidemiology; D012559:Schizophrenia / Q000188:drug therapy*
D014150:Antipsychotic Agents
5-HT2 receptors hypersensitivity; Aripiprazole; Cerebral connectivity; Clozapine; Inhibitory control; Neurotransmission; Orbitofrontal cortex