Atypical antipsychotics and obsessive compulsive symptoms in schizophenia: Literature review

Abstract

Background:

Atypical antipsychotics are actually the first-line treatment in schizophrenia. Obsessive–compulsive symptoms (OCS) are common in patients suffering from schizophrenia and seem to worsen prognosis. Whilst atypical antipsychotics can be a useful augmentation strategy in refractory Obsessive Compulsive Disorder (OCD), their efficacy in case of comorbid obsessive compulsive symptoms in schizophrenia remains unclear.

Aims:

The purpose of this literature review was to examine the relationships between atypical antipsychotics, Obsessive Compulsive Symptoms (OCS) in schizophrenia.

Method:

A systematic MEDLINE database was run using the following key-words: atypical antipsychotics, obsessive compulsive symptoms and schizophrenia (27 articles).

Results:

Clozapine, risperidone,olanzapine and quietiapine may induce or exacerbate OCS in patients with schizophrenia due to their anti-serotoninergic properties. There was no study with ziprazidone,aripiprazole nor amisulpiride. For schizophrenic patients with comorbid OCS, the first line strategy appears to be combination therapy with clomipramine or an Selective Serotoninergic Reuptake Inhibitors (SSRIs)(fluvoxamine, sertraline, fluoxétine) and an atypical antipsychotic. Moreover, in these cases, cognitive behavioural therapy should also be considered.

Conclusions:

Obsessive Compulsive symptoms and schizophrenia are an ongoing matter of debate in terms of comorbidity or constitution of a specific "schizo-obsessive" subtype. Nevertheless, according to the worsening prognosis of this phenomenon, combination therapy (atypical antipsychotics and SSRIs) remains the most relevant therapeutic approach. Moreover, cognitive behavioural therapy studies in this area are required.