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. 2018 Dec;48(16):2668-2675.
doi: 10.1017/S003329171800017X. Epub 2018 Feb 19.

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Emilio Fernandez-Egea  1 , Yulia Worbe  2 , Miguel Bernardo  3 , Trevor W Robbins  4
Affiliations

Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia

Emilio Fernandez-Egea et al. Psychol Med. 2018 Dec.

Abstract

Background: Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions.

Methods: The electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined.

Results: OCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity.

Conclusions: Screening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients.

Keywords: Antipsychotics; clozapine; habit formation; obsessive compulsive disorder.; schizophrenia.

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Figures

Fig. 1.
Fig. 1.
Percentage of significant (cut-off point of 5) of the six OCI-R factors, in the total sample (dark grey), monotherapy (light grey) and poly-pharmacy (black) groups.
Fig. 2.
Fig. 2.
Percentage of significant ‘obsessive’ and ‘checking behaviour’ using the OCI-R factor and a five-point cut-off threshold and length of clozapine treatment in 5-year intervals.
See this image and copyright information in PMC

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