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Chu MY, Wang LL, Lui SS, Chan RC. Could Cognitive Inflexibility Serve as a Potential Biomarker for Schizophrenia-Obsessive-Compulsive Disorder Spectrum? BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:105-106. [PMID: 38298777 PMCID: PMC10829614 DOI: 10.1016/j.bpsgos.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Min-yi Chu
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling-ling Wang
- School of Psychology, Shanghai Normal University, Shanghai, China
| | - Simon S.Y. Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond C.K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Chinese Academy of Sciences Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Mucci F, Toni C, Favaretto E, Vannucchi G, Marazziti D, Perugi G. Obsessive-compulsive Disorder with Comorbid Bipolar Disorders: Clinical Features and Treatment Implications. Curr Med Chem 2019; 25:5722-5730. [PMID: 29119914 DOI: 10.2174/0929867324666171108145127] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) symptoms within the context of a bipolar disorder (BD) have been described since the 19th century. Interestingly, the existence of a relevant overlap between the aforementioned psychiatric syndromes has been confirmed by a number of recent epidemiological and family studies. AIMS The aim of the present paper is to review the clinical features and the therapeutic implications of the OCD-BD comorbidity. DISCUSSION In the last two decades, the frequent association between OCD and BD has been earning a growing interest given its relevant nosological and therapeutic implications. Usually patients suffering from OCD-BD comorbidity show a peculiar clinical course, characterized by a larger number of concomitant depressive episodes and episodic course. In these cases, the treatment with antidepressants is more likely to elicit hypomanic or manic switches, while mood stabilizers significantly improve the overall clinical picture. Moreover, OCD-BD patients are frequently comorbid with a number of other psychiatric disorders, in particular anxiety disorders, social phobia, and different substance abuses, such as alcohol, nicotine, caffeine and sedatives. CONCLUSIONS BD-OCD comorbidity needs further investigations in order to provide more solid evidences to give patients a more precise clinical diagnosis and a more targeted therapeutic approach.
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Affiliation(s)
- Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Cristina Toni
- Istituto di scienze comportamentali G. De Lisio, Carrara, Italy
| | - Ettore Favaretto
- Centro di salute mentale, Ospedale di Bressanone, Bressanone, Italy
| | - Giulia Vannucchi
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Giulio Perugi
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
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Nayak AS, Merchant HH, Nachane HB, Anvekar AR. Risperidone as an effective choice for obsessive-compulsive symptoms and tardive dyskinesia in an Indian quadragenarian with schizo-obsessive disorder. Indian J Psychiatry 2019; 61:311-313. [PMID: 31142912 PMCID: PMC6532469 DOI: 10.4103/psychiatry.indianjpsychiatry_414_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tardive dyskinesia (TD) is a chronic, stigmatizing side effect of typical and atypical antipsychotics that is often debilitating for the patient and resistant to treatment. Obsessive-compulsive symptoms (OCS) may arise at any stage of schizophrenia ranging from prodrome to posttreatment and carry a poor prognosis. Management of both the conditions is a challenging and often fatiguing task for the treating physician. We report a case of schizo-obsessive disorder in an Indian quadragenarian who had developed TD with olanzapine and had failed to show improvement with clozapine and quetiapine. The patient improved dramatically with risperidone. Our findings corroborate with previous literature which has shown risperidone to be effective in treatment of TD and obsessive symptoms, possibly due to its action on the serotonergic system. The authors conclude that risperidone is an effective choice to treat TD and comorbid OCS in patients with schizophrenia.
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Affiliation(s)
- Ajita S Nayak
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Heena H Merchant
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Hrishikesh B Nachane
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Aditya R Anvekar
- Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Mier D, Schirmbeck F, Stoessel G, Esslinger C, Rausch F, Englisch S, Eisenacher S, de Haan L, Meyer-Lindenberg A, Kirsch P, Zink M. Reduced activity and connectivity of left amygdala in patients with schizophrenia treated with clozapine or olanzapine. Eur Arch Psychiatry Clin Neurosci 2019; 269:931-940. [PMID: 30539230 PMCID: PMC6841919 DOI: 10.1007/s00406-018-0965-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/06/2018] [Indexed: 01/01/2023]
Abstract
Obsessive-compulsive symptoms (OCS) in patients with schizophrenia are a common co-occurring condition, often associated with additional impairments. A subgroup of these patients develops OCS during treatment with second-generation antipsychotics (SGAs), most importantly clozapine and olanzapine. So far, little is known about possible neural mechanism of these SGAs, which seem to aggravate or induce OCS. To investigate the role of SGA treatment on neural activation and connectivity during emotional processing, patients were stratified according to their monotherapy into two groups (group I: clozapine or olanzapine, n = 20; group II: amisulpride or aripiprazole, n = 20). We used an fMRI approach, applying an implicit emotion recognition task. Group comparisons showed significantly higher frequency and severity of comorbid OCS in group I than group II. Task specific activation was attenuated in group I in the left amygdala. Furthermore, functional connectivity from left amygdala to right ventral striatum was reduced in group I. Reduced amygdala activation was associated with OCS severity. Recent literature suggests an involvement of an amygdala-cortico-striatal network in the pathogenesis of obsessive-compulsive disorder. The observed differential activation and connectivity pattern of the amygdala might thus indicate a neural mechanism for the development of SGA-associated OCS in patients with schizophrenia. Further neurobiological research and interventional studies are needed for causal inferences.
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Affiliation(s)
- Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany ,Department of Psychology, University of Konstanz, Constance, Germany
| | - Frederike Schirmbeck
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Psychiatry, Arkin Institute for Mental Health, Amsterdam, The Netherlands.
| | - Gabriela Stoessel
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Christine Esslinger
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands ,Department of Psychiatry, Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/University of Heidelberg, Mannheim, Germany ,Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Ansbach, Ansbach, Germany
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Abstract
BACKGROUND Only a few studies have examined the treatability of anxiety disorders in schizophrenia, even though it is generally accepted that in the absence of schizophrenia, the anxiety disorders are safely and effectively treatable. AIM The aim of this study was to study the relation of anxiety disorders with the positive and negative symptoms of schizophrenia and the effect of treatment of different anxiety disorders in schizophrenia patients. MATERIALS AND METHODS The study was carried out on inpatients of a tertiary care psychiatric hospital using a purposive sampling technique. The schizophrenia patients were evaluated for psychopathology and the presence of anxiety disorder at baseline. After being prescribed with antipsychotic medication in a suitable dose for 8 weeks, they were followed up at monthly intervals for the course of both schizophrenia and anxiety disorders. Thereafter, an selective serotonin reuptake inhibitor (SSRI) was also prescribed to the schizophrenia patients with comorbid anxiety disorder, and the patients were again followed up for a period of 8 weeks to assess the progress of schizophrenia and anxiety disorder. RESULTS The prevalence of anxiety disorder in 93 schizophrenia patients included in the present study was 45.16%. The most common comorbid anxiety disorders in schizophrenia patients were panic disorder (18.27%), social anxiety disorder (9.68%), obsessive-compulsive disorder (8.60%), and agoraphobia (6.45%). Schizophrenia patients with anxiety disorder had a significantly higher positive score of the Positive and Negative Symptom Scale for Schizophrenia (PANSS) and a significantly lower score on the negative scale and the general psychopathology scale of the PANSS, as compared to the scores of the schizophrenia group without anxiety disorders. Schizophrenia patients with anxiety disorders responded well to the combination of SSRIs and antipsychotics but not antipsychotics alone. CONCLUSIONS Comorbid anxiety disorders are common in schizophrenia. Schizophrenia patients with anxiety disorders differ significantly from those without anxiety disorders in their basic psychopathology. These anxiety disorders are quite responsive to the SSRIs but not to antipsychotics alone. Further, there is a shorter duration of illness in schizophrenia patients with anxiety disorders as compared to schizophrenia patients without anxiety disorders assigning a prognostic significance to the presence of comorbid anxiety disorders in schizophrenia.
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Affiliation(s)
- Chandra Kiran
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhnad, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
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Grillault Laroche D, Gaillard A. Induced Obsessive Compulsive Symptoms (OCS) in schizophrenia patients under Atypical 2 Antipsychotics (AAPs): review and hypotheses. Psychiatry Res 2016; 246:119-128. [PMID: 27690134 DOI: 10.1016/j.psychres.2016.09.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Diane Grillault Laroche
- Hôpital Universitaire Paul Brousse, Service de Psychiatrie et Addictologie, 12 avenue Paul Vaillant-Couturier, 94800 Villejuif, France; UnitéINSERM 1178, Hôpital Universitaire Paul Brousse, France.
| | - Adeline Gaillard
- Hôpital Sainte-Anne, Service Hopitalo-Universitaire, 1, rue Cabanis, 75014 Paris, France
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Tundo A, Necci R. Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence. World J Psychiatry 2016; 6:449-455. [PMID: 28078209 PMCID: PMC5183997 DOI: 10.5498/wjp.v6.i4.449] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/21/2016] [Accepted: 11/02/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis.
METHODS In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder (OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubMed search using as search string (“obsessive compulsive disorders” or “obsessive compulsive symptoms”) and (“schizophrenia” or “schizoaffective disorder” or “psychosis”) and (“cognitive behavioural therapy”). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.
RESULTS The reviewed evidence indicates that CBT is: (1) safe, i.e., does not worsen psychotic symptoms; (2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity; (3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD co-occurring with psychosis; and (4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by second-generation antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.
CONCLUSION Our results support the use of CBT for OCD in patients with psychosis.
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Cederlöf M, Lichtenstein P, Larsson H, Boman M, Rück C, Landén M, Mataix-Cols D. Obsessive-Compulsive Disorder, Psychosis, and Bipolarity: A Longitudinal Cohort and Multigenerational Family Study. Schizophr Bull 2015; 41:1076-83. [PMID: 25512596 PMCID: PMC4535627 DOI: 10.1093/schbul/sbu169] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Obsessive-compulsive disorder (OCD) often co-occurs with psychotic and bipolar disorders; this comorbidity complicates the clinical management of these conditions. In this population-based longitudinal and multigenerational family study, we examined the patterns of comorbidity, longitudinal risks, and shared familial risks between these disorders. Participants were individuals with a diagnosis of OCD (n = 19,814), schizophrenia (n = 58,336), bipolar disorder (n = 48,180), and schizoaffective disorder (n = 14,904) included in the Swedish Patient Register between January 1969 and December 2009; their first-, second-, and third-degree relatives; and population-matched (1:10 ratio) unaffected comparison individuals and their relatives. The Swedish Prescribed Drug Register was used to control for the potential effect of medication in the longitudinal analyses. Individuals with OCD had a 12-fold increased risk of having a comorbid diagnosis of schizophrenia and a 13-fold increased risk of bipolar disorder and schizoaffective disorder. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for later diagnosis of all other disorders, and vice versa. The risk of bipolar disorder was reduced, but not eliminated, when the use of selective serotonin reuptake inhibitors was adjusted for. OCD-unaffected first-, second-, and third-degree relatives of probands with OCD had a significantly increased risk for all 3 disorders; the magnitude of this risk decreased as the genetic distance increased. We conclude that OCD is etiologically related to both schizophrenia spectrum and bipolar disorders. The results have implications for current gene-searching efforts and for clinical practice.
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Affiliation(s)
- Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;
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Swets M, Van Dael F, Roza S, Schoevers R, Myin-Germeys I, de Haan L, Genetic Risk and Outcome of Psychosis (GROUP) investigators. Evidence for a Shared Etiological Mechanism of Psychotic Symptoms and Obsessive-Compulsive Symptoms in Patients with Psychotic Disorders and Their Siblings. PLoS One 2015; 10:e0125103. [PMID: 26061170 PMCID: PMC4465647 DOI: 10.1371/journal.pone.0125103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/05/2015] [Indexed: 11/18/2022] Open
Abstract
The prevalence of obsessive-compulsive disorder in subjects with psychotic disorder is much higher than in the general population. The higher than chance co-occurrence has also been demonstrated at the level of subclinical expression of both phenotypes. Both extended phenotypes have been shown to cluster in families. However, little is known about the origins of their elevated co-occurrence. In the present study, evidence for a shared etiological mechanism was investigated in 3 samples with decreasing levels of familial psychosis liability: 987 patients, 973 of their unaffected siblings and 566 healthy controls. The association between the obsessive-compulsive phenotype and the psychosis phenotype c.q. psychosis liability was investigated. First, the association was assessed between (subclinical) obsessive-compulsive symptoms and psychosis liability. Second, in a cross-sib cross-trait analysis, it was examined whether (subclinical) obsessive-compulsive symptoms in the patient were associated with (subclinical) psychotic symptoms in the related unaffected sibling. Evidence was found for both associations, which is compatible with a partially shared etiological pathway underlying obsessive-compulsive and psychotic disorder. This is the first study that used a cross-sib cross-trait design in patients and unaffected siblings, thus circumventing confounding by disease-related factors present in clinical samples.
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Affiliation(s)
- Marije Swets
- Arkin Mental Health and Addiction Treatment Centre, Amsterdam, the Netherlands
| | - Frank Van Dael
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Sabine Roza
- Department of psychiatry, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Robert Schoevers
- Department of psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
| | - Lieuwe de Haan
- Academic Medical Centre University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
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Kim SW, Jeong BO, Kim JM, Shin IS, Hwang MY, Paul Amminger G, Nelson B, Berk M, McGorry P, Yoon JS. Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness. Psychiatry Res 2015; 226:368-75. [PMID: 25681006 DOI: 10.1016/j.psychres.2015.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Bo-Ok Jeong
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Michael Y Hwang
- Department of Psychiatry, New York Medical College, F.D.R. VAMC (116A), 2094 Albany Post Road, Montrose, New York 10548, USA
| | - G Paul Amminger
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Barnaby Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Michael Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia; Impact Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Patrick McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea.
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11
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Devi S, Rao NP, Badamath S, Chandrashekhar CR, Janardhan Reddy YC. Prevalence and clinical correlates of obsessive-compulsive disorder in schizophrenia. Compr Psychiatry 2015; 56:141-8. [PMID: 25308405 DOI: 10.1016/j.comppsych.2014.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive-compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive-compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive-compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive-compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale-Brown Obsessive-Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive-compulsive symptoms in patients with schizophrenia was 24% (n=48); 37 of them had obsessive-compulsive disorder (OCD) and 11 had obsessive-compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies.
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Affiliation(s)
- Sugnyani Devi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Centre for Neuroscience, Indian Institute of Science, Bangalore, India
| | - Suresh Badamath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - C R Chandrashekhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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13
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Fonseka TM, Richter MA, Müller DJ. Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature. Curr Psychiatry Rep 2014; 16:510. [PMID: 25256097 DOI: 10.1007/s11920-014-0510-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Second generation antipsychotics (SGAs) have been implicated in the de novo emergence and exacerbation of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Among SGAs, clozapine, olanzapine, and risperidone are the most prominent agents associated with these sequelae, according to case reports. Comorbid OCS can impede recovery by compromising treatment benefits, medication compliance, and clinical prognoses. Previous reviews of SGA-induced OCS have predominantly focused on descriptive case reports, with limited attention paid toward experimental findings. To address this paucity of data, we sought to review the effects of SGAs on OCS in schizophrenia in the experimental literature, while addressing the role of different treatment (duration, dose, serum levels) and pharmacogenetic factors. Our findings suggest that clozapine confers the greatest risk of OCS in schizophrenia, with 20 to 28% of clozapine-treated patients experiencing de novo OCS, in addition to 10 to 18% incurring an exacerbation of pre-existing OCS. Clozapine can also yield full threshold obsessive-compulsive disorder (OCD), in some cases. Olanzapine is another high risk drug for secondary OCS which occurs in 11 to 20% of schizophrenic patients receiving olanzapine therapy. At this time, there is insufficient experimental evidence to characterize the effects of other SGAs on OCS. Despite some experimental support for the involvement of longer treatment duration and genetic factors in mediating drug-induced OCS, more research is needed to clearly elucidate these associations. Based on these results, schizophrenic patients should be routinely monitored for OCS throughout the course of SGA treatment, particularly when clozapine or olanzapine is administered.
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Affiliation(s)
- Trehani M Fonseka
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
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Juven-Wetzler A, Fostick L, Cwikel-Hamzany S, Balaban E, Zohar J. Treatment with Ziprasidone for schizophrenia patients with OCD. Eur Neuropsychopharmacol 2014; 24:1454-62. [PMID: 25048540 DOI: 10.1016/j.euroneuro.2014.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
Abstract
Comorbidity of obsessive-compulsive disorder (OCD) has been observed in about 15% of schizophrenic patients and has been associated with poor prognosis. Therefore, there is a need for specific treatment options for these patients (schizo-obsessive, ScOCD). This is an open, prospective study, aiming to test the efficacy of Ziprasidone (80-200mg/d) in ScOCD patients and comparing the response to the treatment between stable schizophrenic (N=16) and stable ScOCD (N=29) patients. Treatment effect with Ziprasidone was different in schizophrenic patients when stratified based on OCD comorbidity. Overall, the effect on OCD symptoms (as measured by the Yale Brown Obsessive Compulsive Scale, YBOCS) was found to be bimodal-either no response or exacerbation (for 45% of the patients, n=13) or significant improvement of symptoms (55%, n=16). Those who improved in OCD symptoms, improved also in negative and general schizophrenia symptoms, while ScOCD-unimproved group worsened in all symptoms. Whereas schizophrenic patients without OCD responded in a modest Gaussian distribution, they improved in schizophrenia negative symptoms and in general anxiety. This data suggests that schizo-obsessive disorder is a distinct and complex condition with more than one underlying pathogenesis. Definition of these ScOCD subgroups defined by their response to Ziprasidone might contribute to personalized medicine within the OCD-schizophrenia spectrum. Moreover, this finding suggests that ScOCD may be considered as a special schizophrenic subtype and its inclusion in schizophrenia treatment studies need to be further explored due to its divergent response.
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Affiliation(s)
| | - Leah Fostick
- Department of Communication Disorders, Ariel University, Ariel, Israel.
| | | | - Evgenya Balaban
- Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
| | - Joseph Zohar
- Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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Hypochondriasis and obsessive-compulsive disorder in schizophrenic patients treated with clozapine vs other atypical antipsychotics. CNS Spectr 2014; 19:340-6. [PMID: 24176043 DOI: 10.1017/s1092852913000795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs. METHODS We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs. RESULTS Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1-3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047). CONCLUSIONS Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.
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Psychopathology and quality of life among patients with comorbidity between schizophrenia spectrum disorder and obsessive-compulsive disorder: no evidence for a "schizo-obsessive" subtype. Compr Psychiatry 2014; 55:1165-73. [PMID: 24794642 DOI: 10.1016/j.comppsych.2014.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Epidemiological studies have found that obsessive-compulsive disorder (OCD) is estimated to occur in up to 12% of patients with schizophrenia. Furthermore, several etiopathogenic mechanisms have been postulated for understanding this co-occurrence. Whether this subgroup of "schizo-obsessive" patients may be posed as a clinical entity with a distinct psychopathological and functioning profile remains unclear. METHOD A sample of adult patients who met DSM-IV criteria for both schizophrenia/schizoaffective disorder and OCD (n=30) was compared with a "non-OCD schizophrenic" group (n=37) and another subset of "non-schizophrenic OCD" patients (n=30). The Positive and Negative Syndrome Scale (PANSS), the Scale to Assess Unawareness of Mental Disorder (SUMD), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Brown Assessment of Beliefs Scale (BABS), the Clinical Global Severity scale (CGI), the Quality of Life Scale (QLS), and the Beck's Depression Inventory (BDI) were used. RESULTS We found that "schizo-obsessive" subjects did not show significant differences in any outcome measures when compared to the "non-OCD schizophrenic" group. Furthermore, statistical analyses also revealed that the "non-schizophrenic OCD" group tended to have lower severity of psychopathology as well as greater quality of life than both psychotic groups. CONCLUSIONS These findings indicate that comorbidity between schizophrenia/schizoaffective disorder and OCD does not comprise a distinct clinical entity, particularly when compared to "non-OCD schizophrenia" disorder. Discrepancies among previous studies may be justified by methodological divergences.
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Zink M. Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment. Adv Med 2014; 2014:317980. [PMID: 26556409 PMCID: PMC4590963 DOI: 10.1155/2014/317980] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/19/2014] [Indexed: 12/17/2022] Open
Abstract
Insight into the biological pathomechanism of a clinical syndrome facilitates the development of effective interventions. This paper applies this perspective to the important clinical problem of obsessive-compulsive symptoms (OCS) occurring during the lifetime diagnosis of schizophrenia. Up to 25% of schizophrenia patients suffer from OCS and about 12% fulfil the diagnostic criteria of obsessive-compulsive disorder (OCD). This is accompanied by marked subjective burden of disease, high levels of anxiety, depression and suicidality, increased neurocognitive impairment, less favourable levels of social and vocational functioning, and greater service utilization. Comorbid patients can be assigned to heterogeneous subgroups. It is assumed that second generation antipsychotics (SGAs), most importantly clozapine, might aggravate or even induce second-onset OCS. Several epidemiological and pharmacological arguments support this assumption. Specific genetic risk factors seem to dispose patients with schizophrenia to develop OCS and risk-conferring polymorphisms has been defined in SLC1A1, BDNF, DLGAP3, and GRIN2B and in interactions between these individual genes. Further research is needed with detailed characterization of large samples. In particular interactions between genetic risk constellations, pharmacological and psychosocial factors should be analysed. Results will further define homogeneous subgroups, which are in need for differential causative interventions. In clinical practise, schizophrenia patients should be carefully monitored for OCS, starting with at-risk mental states of psychosis and longitudinal follow-ups, hopefully leading to the development of multimodal therapeutic interventions.
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Affiliation(s)
- Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, P.O. Box 12 21 20, 68072 Mannheim, Germany
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The obsessive compulsive spectrum in schizophrenia, a meta-analysis and meta-regression exploring prevalence rates. Schizophr Res 2014; 152:458-68. [PMID: 24361303 DOI: 10.1016/j.schres.2013.10.033] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/16/2013] [Accepted: 10/25/2013] [Indexed: 01/26/2023]
Abstract
AIMS The aims of this study were to conduct a meta-analysis and meta-regression to estimate the prevalence rates for obsessive compulsive symptoms (OCS) and obsessive compulsive disorder (OCD) in schizophrenia, and to investigate what influences these prevalence rates. METHOD Studies were identified via an online OVID database search, including PsychInfo, Embase and Medline until December 2009. RESULTS Forty-three studies summarizing outcomes for 3978 subjects met inclusion criteria. The mean OCD prevalence is 12.3%, slightly increasing to 13.6% after adjustment in meta-regression. The prevalence rate of OCS, defined as any obsession or compulsion is 30.7% (30.3% adjusted). Higher severity of OCS, DIGS assessment, and Sub-Saharan African origin of study are associated with a lower OCS/OCD prevalence rate, use of DSM-IV edition, Y-BOCS assessment and longer schizophrenia history are associated with a higher prevalence rate. CONCLUSION The prevalence of OCS and OCD in schizophrenia is substantial, specifically in more chronic patient populations and is influenced by the method of assessment.
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Schirmbeck F, Zink M. Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors. Front Pharmacol 2013; 4:99. [PMID: 23950745 PMCID: PMC3738863 DOI: 10.3389/fphar.2013.00099] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/22/2013] [Indexed: 12/17/2022] Open
Abstract
A large subgroup of around 25% of schizophrenia patients suffers from obsessive-compulsive symptoms (OCS) and about 12% fulfill the diagnostic criteria of an obsessive-compulsive disorder (OCD). The additional occurrence of OCS is associated with high subjective burden of disease, additional neurocognitive impairment, poorer social and vocational functioning, greater service utilization and high levels of anxiety and depression. Comorbid patients can be assigned to heterogeneous subgroups. One hypothesis assumes that second generation antipsychotics (SGAs), most importantly clozapine, might aggravate or even induce second-onset OCS. Several arguments support this assumption, most importantly the observed chronological order of first psychotic manifestation, start of treatment with clozapine and onset of OCS. In addition, correlations between OCS-severity and dose and serum levels and duration of clozapine treatment hint toward a dose-dependent side effect. It has been hypothesized that genetic risk-factors dispose patients with schizophrenia to develop OCS. One study in a South Korean sample reported associations with polymorphisms in the gene SLC1A1 (solute carrier family 1A1) and SGA-induced OCS. However, this finding could not be replicated in European patients. Preliminary results also suggest an involvement of polymorphisms in the BDNF gene (brain-derived neurotrophic factor) and an interaction between markers of SLC1A1 and the gene DLGAP3 (disc large associated protein 3) as well as GRIN2B (N-methyl-D-aspartate receptor subunit 2B). Further research of well-defined samples, in particular studies investigating possible interactions of genetic risk-constellations and pharmacodynamic properties, are needed to clarify the assumed development of SGA-induced OCS. Results might improve pathogenic concepts and facilitate the definition of at risk populations, early detection and monitoring of OCS as well as multimodal therapeutic interventions.
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Affiliation(s)
- Frederike Schirmbeck
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Faculty Medicine Mannheim, Heidelberg University Mannheim, Germany
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de Haan L, Sterk B, van der Valk R. Presence of obsessive compulsive symptoms in first-episode schizophrenia or related disorders is associated with subjective well-being and quality of life. Early Interv Psychiatry 2013; 7:285-90. [PMID: 22747797 DOI: 10.1111/j.1751-7893.2012.00377.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 05/20/2012] [Indexed: 11/27/2022]
Abstract
AIM The study aims to evaluate whether the presence of obsessive compulsive symptoms (OCS) in first-episode schizophrenia patients is associated with subjective well-being or quality of life. METHODS This study used a cross-sectional study of consecutively diagnosed patients with a first episode of schizophrenia or related disorder. RESULTS There were 23 out of 198 (12%) consecutively assessed patients that reported co-morbid OCS. Co-morbid OCS were associated with a lower mean total score on a subjective well-being scale (P ≤ 0.001), especially on the social integration subscale (P = 0.002) and emotional regulation subscale (P = 0.008), and lower scores on subjective aspects of quality of life (P = 0.043), especially concerning mental health (P = 0.001) and physical health (P = 0.002). CONCLUSION These results support the clinical relevance of OCS co-morbidity in schizophrenia or related disorders and the need for research into specific interventions.
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Affiliation(s)
- Lieuwe de Haan
- Department of Psychiatry, Early Psychosis, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Polymorphisms in the glutamate transporter gene SLC1A1 and obsessive-compulsive symptoms induced by second-generation antipsychotic agents. Psychiatr Genet 2013; 22:245-52. [PMID: 22531293 DOI: 10.1097/ypg.0b013e328353fbee] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A large subgroup of schizophrenic patients develops obsessive-compulsive symptoms (OCS) during treatment with second-generation antipsychotics (SGA). A genetic risk factor for these secondary OCS was recently described in the gene SLC1A1 encoding the neuronal glutamate transporter excitatory amino acid carrier 1. The aim of this study was to replicate these findings in a European sample. METHODS A total of 103 schizophrenic patients treated with SGAs were included. Three single nucleotide polymorphisms in SLC1A1 (rs2228622, rs3780412 and rs3780413), which had been associated with SGA-induced OCS, were investigated. Single marker and haplotype analyses were tested with logistic regressions using age, sex and medication type as covariates. RESULTS Treatment with markedly antiserotonergic SGAs such as clozapine was more prevalent in the subgroup of patients with comorbid OCS (P<0.001). The dosage and duration of clozapine treatment correlated significantly with the severity of OCS. In contrast to the Asian sample, no genetic associations were found with OCS. CONCLUSION Larger samples are necessary to unravel the interplay of pharmacological and genetic risk factors for OCS in schizophrenia.
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Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M. Differential effects of antipsychotic agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol 2013; 27:349-57. [PMID: 23095245 DOI: 10.1177/0269881112463470] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indirect evidence supports the assumption that antiserotonergic second-generation antipsychotics (SGA) induce and aggravate obsessive-compulsive symptoms (OCS) in schizophrenia. However, multimodal studies assessing the long-term interaction of pharmacotherapy and psychopathology are missing. Over 12 months, we followed-up 75 schizophrenia patients who were classified into two groups according to antipsychotic treatment: clozapine or olanzapine (group I) versus aripiprazole or amisulpride (group II). We applied the Yale Brown Obsessive Compulsive Scale (YBOCS) and investigated between-group changes over time as the primary endpoint. Group I showed markedly higher YBOCS scores at both time points. Repeated measure analyses of variance (ANOVAs) revealed significant interaction effects of group and time (per protocol sample (PP): p=0.006). This was due to persistently high OCS severity within group I, and decreasing YBOCS scores within group II. OCS severity correlated significantly with the negative and general psychopathology subscales of the Positive and Negative Syndrome Scale (PANSS), as well as with depressive symptoms. The progressive differences in OCS severity between our groups support the assumption of differential pharmacodynamic effects on comorbid OCS in schizophrenia. Further studies should address the pathogenetic mechanism, define patients at risk and facilitate early detection as well as therapeutic interventions.
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Affiliation(s)
- Frederike Schirmbeck
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Sheehan DV, Harnett-Sheehan K, Hidalgo RB, Janavs J, McElroy SL, Amado D, Suppes T. Randomized, placebo-controlled trial of quetiapine XR and divalproex ER monotherapies in the treatment of the anxious bipolar patient. J Affect Disord 2013; 145:83-94. [PMID: 22920718 DOI: 10.1016/j.jad.2012.07.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/08/2012] [Accepted: 07/17/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anxiety disorders complicate the treatment of bipolar disorder but are seldom the focus of bipolar treatment studies. METHODS The anxiolytic effect of quetiapine XR 50-300 mg/day compared to divalproex ER (500-3000 mg/day) was tested in an 8-week, double-blind, placebo-controlled, randomized clinical trial in 149 patients with bipolar disorder and a co-occurring panic disorder or GAD. The primary efficacy measure was the Clinician Global Improvement-21 Anxiety Scale (CGI-21). Secondary measures included the Hamilton Anxiety Scale (HAM-A) and Sheehan Panic Disorder Scale (SPS). RESULTS Repeated measures last-observation-carried-forward (LOCF) analyses of variance demonstrated significant treatment-by-time interaction effects on 3 of the 4 anxiety measures. Quetiapine XR at a mean endpoint dose of 186 mg/day produced rapid sustained improvements relative to baseline, divalproex ER and placebo on anxiety. Mean baseline-to-endpoint improvement was significantly greater for quetiapine XR compared to divalproex ER and placebo on the HAM-A and SPS. Both active medications were well tolerated, but weight gain was higher on quetiapine XR. LIMITATIONS The study was limited to 8 weeks and to patients with bipolar disorder and comorbid panic disorder or GAD. The results may not be applicable to quetiapine XR as an add-on treatment to mood stabilizers or to bipolar disorder comorbid with other anxiety disorders. CONCLUSIONS Quetiapine XR in a dose range of 50-300 mg/day appears to reduce anxiety in bipolar patients with comorbid panic disorder or GAD treated for 8 weeks. The efficacy of other second-generation antipsychotics and mood stabilizers in patients with bipolar disorder and a co-occurring anxiety disorder should be investigated in double-blind, placebo-controlled studies.
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Affiliation(s)
- David V Sheehan
- Clinical and Translational Science Institute, University of South Florida, College of Medicine, 3515 East Fletcher Ave, Tampa, FL 33613, USA.
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Is a schizo-obsessive subtype associated with cognitive impairment? Results from a large cross-sectional study in patients with psychosis and their unaffected relatives. J Nerv Ment Dis 2013; 201:30-5. [PMID: 23274292 DOI: 10.1097/nmd.0b013e31827ab2b2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current study investigated whether candidate cognitive endophenotypes may be used to validate a schizo-obsessive subtype. Using within-subject random effect regression analyses and cross-trait cross-relative analyses, we evaluated the association between obsessive-compulsive symptoms (OCSs) and cognitive performance in 984 patients with nonaffective psychosis (22.5% with OCSs), 973 unaffected siblings (7.7% with OCSs), 851 parents (4.2% with OCSs), and 573 controls (4.5% with OCSs). No significant within-subject associations between OCSs and cognitive functioning were found for patients and siblings. Severity of OCSs was associated with worse set-shifting ability in parents and worse processing speed in controls, but effect sizes were small (0.10 and 0.05 respectively). Cross-trait cross-relative analyses yielded no significant results. Contrary to our expectations, neither within-subject analyses nor cross-relative analyses yielded a clear association between OCSs and cognitive performance. Results do not support a schizo-obsessive subtype associated with cognitive impairment.
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Bruno A, Micò U, Pandolfo G, Mallamace D, Abenavoli E, Di Nardo F, D'Arrigo C, Spina E, Zoccali RA, Muscatello MRA. Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. J Psychopharmacol 2012; 26:1456-62. [PMID: 22351381 DOI: 10.1177/0269881111431751] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The present 16-week double-blind, randomized, placebo-controlled trial had the aim to explore the efficacy of lamotrigine add-on pharmacotherapy on clinical symptomatology and cognitive functioning in a sample of patients with treatment-resistant obsessive-compulsive disorder (OCD) receiving serotonin reuptake inhibitors (SRIs). After clinical and neurocognitive assessments, patients were randomly allocated to receive, in a double-blind design, 100 mg/day of lamotrigine or a placebo. A final sample of 33 patients completed the study. The results obtained indicate that lamotrigine added to stable SRI treatment substantially improved obsessive-compulsive (Yale-Brown Obsessive Compulsive Scale: obsessions, p < 0.0001; compulsions, p < 0.0001; total score, p < 0.0001), and affective symptoms (Hamilton Rating Scale for Depression p < 0.0001). Regarding cognitive functions, improvement was observed only in Semantic Fluency (p = 0.004). The findings provide evidence that lamotrigine augmentation of SRI treatment is well tolerated and may be proposed as an effective therapeutic strategy to improve outcome in treatment-resistant OCD.
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Affiliation(s)
- Antonio Bruno
- Section of Psychiatry, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Messina, Italy.
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Schirmbeck F, Zink M. Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review. Curr Neuropharmacol 2012; 10:88-95. [PMID: 22942882 PMCID: PMC3286851 DOI: 10.2174/157015912799362724] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 08/22/2011] [Accepted: 08/30/2011] [Indexed: 01/01/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is rarely associated with schizophrenia, whereas 20 to 30% of schizophrenic patients, suffer from comorbid obsessive-compulsive symptoms (OCS). So far no single pathogenetic theory convincingly explained this fact suggesting heterogeneous subgroups. Based on long-term case observations, one hypothesis assumes that second-onset OCS in the course of schizophrenia might be a side effect of second generation antipsychotics (SGA), most importantly clozapine (CLZ). This review summarizes the supporting epidemiological and pharmacological evidence: Estimations on prevalence of OCS increase in more recent cross-sectional studies and in later disease stages. Longitudinal observations report the de novo-onset of OCS under clozapine treatment. This association has not been reported with first generation antipsychotics (FGA) or SGAs with mainly dopaminergic mode of action. Finally, significant correlations of OCS-severity with duration of treatment, dose and serum levels suggest clozapine-induced OCS. However, supposed causal interactions need further verifications. It is also unclear, which neurobiological mechanisms might underlie the pathogenetic process. Detailed genotypic and phenotypic characterizations of schizophrenics with comorbid OCS regarding neurocognitive functioning and activation in sensitive tasks of functional magnetic imaging are needed. Multimodal large-scaled prospective studies are necessary to define patients at risk for second-onset OCS and to improve early detection and therapeutic interventions.
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Affiliation(s)
- Frederike Schirmbeck
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, P.O. Box 12 21 20, D-68072 Mannheim, Germany
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Hashim HM, Fawzy N, Fawzi MM, Karam RA. Brain-derived neurotrophic factor Val66Met polymorphism and obsessive-compulsive symptoms in Egyptian schizophrenia patients. J Psychiatr Res 2012; 46:762-6. [PMID: 22521161 DOI: 10.1016/j.jpsychires.2012.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) has been advanced as a candidate gene for schizophrenia. BDNF promote the function and growth of 5-HT neurons in the brain and modulate the synaptic plasticity of DRD3-secreting neurons in the striatum, suggesting involvement of BDNF in the mediation of obsessive-compulsive disorder. OBJECTIVES To test the hypothesis that the BDNF Val66Met polymorphism influence obsessive-compulsive symptoms (OCS) in schizophrenia, we examined the association between the BDNF Val66Met genotypes and OCS in a group of patients with schizophrenia. METHODS 320 schizophrenia patients were assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). BDNF Val66Met polymorphism was genotyped using PCR-RFLP method, and severity of OCS were compared between the genotype groups. RESULTS Out of the 320 schizophrenia patients, 120 patients (37.5%) had significant OCS. There was a significant excess of valine allele in the schizophrenia with-OCS group compared to the without-OCS group. The mean YBOCS scores were significantly different among the three genotype groups. Val/Val homozygote patients had higher mean YBOCS scores compared to Val/Met genotype (p = 0.0001) as well as to the Met/Met homozygote group (p = 0.003). CONCLUSION Our data suggested an association between BDNF Val66Met polymorphism and OCS in Egyptian schizophrenia patients.
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Affiliation(s)
- Haytham M Hashim
- Department of Psychiatry, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Soc Psychiatry Psychiatr Epidemiol 2012; 47:339-49. [PMID: 21287144 DOI: 10.1007/s00127-010-0337-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/17/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although subthreshold conditions are associated with impairment in numerous disorders, research on obsessive-compulsive disorder (OCD) below the diagnostic threshold of DSM-IV in the general population is limited. PURPOSE To estimate the DSM-IV 12-month prevalence, comorbidity and impairment of OCD, subthreshold OCD (i.e., fulfilling some but not all core DSM-IV criteria), and obsessive-compulsive symptoms (OCS) (i.e., endorsement of OCS without fulfilling any core DSM-IV criteria) in a general population sample. METHODS Data from the German National Health Interview and Examination Survey-Mental Health Supplement (N = 4181, age 18-65 years), based on the standardized diagnostic Munich Composite International Diagnostic Interview. RESULTS The 12-month prevalence of OCD was 0.7%, subthreshold OCD was 4.5%, and OCS was 8.3%. Subjects in all three groups showed higher comorbidity (odds ratios [ORs] ≥ 3.3), compared to those without OCS. The OCD, subthreshold OCD and OCS were all associated with increased odds of substance abuse/dependence-, mood-, anxiety- and somatoform disorders, with especially strong associations with possible psychotic disorder (ORs ≥ 4.1) and bipolar disorders (ORs ≥ 4.7). Participants in all three groups showed higher impairment (ORs ≥ 3.1) and health-care utilization (ORs ≥ 2.4), compared to those without OCS, even after controlling for covariates. CONCLUSIONS Individuals with subthreshold OCD and OCS, not currently captured by DSM-IV OCD criteria, nevertheless show substantial comorbidity, impairment and health-care utilization. This should be taken into account in future conceptualization and classification of OCD and clinical care.
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Hadi E, Greenberg Y, Sirota P. Obsessive-compulsive symptoms in schizophrenia: prevalence, clinical features and treatment. A literature review. World J Biol Psychiatry 2012; 13:2-13. [PMID: 21554025 DOI: 10.3109/15622975.2011.559271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the prevalence of obsessive-compulsive symptoms in schizophrenia, the clinical features of the sub-group of patients with schizophrenia and obsessive-compulsive symptoms and treatment options for these patients. METHOD A literature review of studies investigating the prevalence, clinical features and treatment of patients with schizophrenia and obsessive-compulsive symptoms. RESULTS The prevalence of obsessive-compulsive symptoms in schizophrenic patients, while generally found to be higher than in the general population, varies widely between different studies. Differences in symptom severity between schizophrenic patients with obsessive-compulsive symptoms and those without have been found, however findings so far have been inconsistent. A number of case reports have implicated atypical antipsychotic medication in the emergence of obsessive-compulsive symptoms. There is evidence to support a combined treatment with an antipsychotic agent and an anti-obsessional agent. CONCLUSION Studies investigating the prevalence of obsessive-compulsive symptoms in schizophrenia and their effect on the clinical symptoms have yielded inconsistent results and further studies using larger samples of patients and looking at different subgroups of schizophrenic patients are required. Treatment options need further research to investigate whether the results of relatively small studies can be replicated.
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Affiliation(s)
- Elliot Hadi
- Abarbanel Mental Health Centre, Bat Yam, Israel
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Schirmbeck F, Esslinger C, Rausch F, Englisch S, Meyer-Lindenberg A, Zink M. Antiserotonergic antipsychotics are associated with obsessive-compulsive symptoms in schizophrenia. Psychol Med 2011; 41:2361-2373. [PMID: 21466748 DOI: 10.1017/s0033291711000419] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Epidemiological investigations show that up to 30% of schizophrenic patients suffer from obsessive-compulsive symptoms (OCS) associated with negative impact on the general prognosis. It has been proposed that antiserotonergic second-generation antipsychotics (SGAs) might induce OCS, but investigations of large samples integrating psychopathology, neuropsychology and psychopharmacology are missing. METHOD We stratified 70 patients with schizophrenia according to their mode of antipsychotic treatment: clozapine and olanzapine (group I) compared with aripiprazole and amisulpride (group II). The groups were matched according to age, sex, educational levels and severity of the psychotic disorder (Positive and Negative Syndrome Scale). As the primary endpoint, we evaluated OCS severity (Yale-Brown Obsessive-Compulsive Scale). RESULTS OCS were significantly more prevalent and severe in group I, in which OCS severity correlated with dosage of clozapine and duration of treatment. Pronounced cognitive deficits in group I were found in visuospatial perception and visual memory (Wechsler Adult Intelligence Scale-Revised block design, Rey-Osterrieth Complex Figure Test), impulse inhibition (go/no-go test), higher perseveration scores (Wisconsin Card Sorting Test) and reduced set-shift abilities (Trail Making Test Part B, Set-shift Task). These cognitive domains correlated with OCS severity. CONCLUSIONS OCS in schizophrenia are associated with antiserotonergic SGA treatment, but longitudinal studies have to prove causality. Before starting treatment with antiserotonergic SGAs, specific neurocognitive domains should be evaluated, as visuospatial learning and impulse inhibition performance might allow early detection of OCS secondary to antipsychotic treatment in schizophrenia.
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Affiliation(s)
- F Schirmbeck
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
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Sterk B, Lankreijer K, Linszen DH, de Haan L. Obsessive-compulsive symptoms in first episode psychosis and in subjects at ultra high risk for developing psychosis; onset and relationship to psychotic symptoms. Aust N Z J Psychiatry 2011; 45:400-6. [PMID: 21087087 DOI: 10.3109/00048674.2010.533363] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence of obsessive-compulsive symptoms and obsessive-compulsive disorder in patients with schizophrenia or related disorders or subjects at ultra high risk for development of psychosis. Secondly, to determine the time of occurrence of obsessive-compulsive symptoms related to the onset of first psychosis. METHOD We collected data on all patients who were referred consecutively to our specialized clinic for first episode psychosis patients and ultra high risk subjects in Amsterdam between 1 July 2006 and 1 July 2008. Diagnosis of psychotic disorders was established using the Comprehensive Assessment of Symptoms and History schedule. Obsessions and compulsions were defined in accordance with DSM-III-R criteria and assessed by clinicians. We analyzed the onset of obsessive-compulsive symptoms and its relation to the onset of first episode psychosis. RESULTS When a strict definition of obsessive-compulsive symptoms is used, 9.3% (n = 18) of patients with schizophrenia or a related disorder exhibited obsessive-compulsive symptoms and 1.5% also met criteria for obsessive-compulsive disorder. The onset of obsessive-compulsive symptoms occurred before, concurrent with and after onset of first episode psychosis in the following proportion of patients: 7/18, 3/18, 8/18. We found a prevalence of 20.7% of obsessive-compulsive symptoms in ultra high risk subjects. CONCLUSION Using a strict definition of obsessive-compulsive symptoms, we found relatively low prevalence rates of obsessive-compulsive symptoms and obsessive-compulsive disorder in patients with schizophrenia or related disorders; the rates are even lower than known rates of obsessive-compulsive symptoms and obsessive-compulsive disorder in the general population. Obsessive-compulsive symptoms rates in ultra high risk subjects are comparable to those in the general population. Further investigation of the predictive validity of obsessive-compulsive symptoms in ultra high risk subjects for developing psychosis is needed. Obsessive-compulsive symptoms either develop prior, during or after the onset of first episode psychosis.
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Affiliation(s)
- Bouke Sterk
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam Meibergdreef 5, 1105 AZ Amsterdam, Netherlands.
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Boyette L, Swets M, Meijer C, Wouters L. Factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) in a large sample of patients with schizophrenia or related disorders and comorbid obsessive-compulsive symptoms. Psychiatry Res 2011; 186:409-13. [PMID: 20800902 DOI: 10.1016/j.psychres.2010.07.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/07/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
Abstract
In the past decade there has been an increasing interest in the levels of obsessive-compulsive symptoms (OCS) found in patients with schizophrenia or related disorders. The widely acknowledged gold standard measure of the severity of OCS is the content-free version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1989a,b). However, factor analytic research in patients with obsessive-compulsive disorder (OCD) provided varied results. So far no study has been conducted on the factor structure of the Y-BOCS in patients with schizophrenia. The present study addresses this issue. We administered the Y-BOCS in a sample of 217 patients with schizophrenia or related disorders and comorbid OCS who participated in a multicentre cohort study. We used principal component analysis (PCA) to explore the underlying factor structure. A two-factor solution consistent with the originally proposed scoring structure of the Y-BOCS provided the optimal fit. We also found some support for a three-factor solution consistent with earlier findings by Kim et al. and Moritz et al. (Kim et al., 1994; Moritz et al., 2002). The produced factors showed good reliability and strong correlations with the Y-BOCS Total score. However, the resistance to compulsion item failed to demonstrate adequate correlation to the Total score, a finding consistent with earlier findings in several studies with patients with OCD.
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Affiliation(s)
- Lindy Boyette
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
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Üçok A, Ceylan ME, Tihan AK, Lapçin S, Ger C, Tükel R. Obsessive compulsive disorder and symptoms may have different effects on schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:429-33. [PMID: 20816715 DOI: 10.1016/j.pnpbp.2010.08.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 08/24/2010] [Accepted: 08/24/2010] [Indexed: 11/16/2022]
Abstract
The aim of this study is to investigate the possible different effects of obsessive compulsive disorder (OCD) and obsessive compulsive symptoms (OCS) on schizophrenia illness in regard to clinical characteristics such as severity of symptomatology. We included 184 patients with schizophrenia on monotherapy with a stable dose of antipsychotics for at least three months. Severity of clinical symptoms was evaluated by Positive and Negative Syndrome Scale. OCS was examined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Checklist. We also assessed OCD by using Y-BOCS. Seventeen percent of the patients were diagnosed with current OCD, while 17.4% of the patients were found to have OCS without OCD. Age of onset for OCD group was earlier than non-OCS group (p=0.007). The rate of occupation was higher (p=0.001), prevalence of other comorbid psychiatric disorders was lower (p=0.05), number of hospitalization was lower (p=0.03), GAF score was higher (p=0.03) and duration of education was longer (p=0.02) in the OCS group than in the non-OCS group. The rate of occupation was higher (p=0.04) and that rate of comorbid psychiatric disorders was lower (p=0.01) in the OCS group than in the OCD group. We found more OCS in patients using atypical antipsychotics (p=0.03). Our findings suggest that OCD and OCS might have different effects on schizophrenia.
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Affiliation(s)
- Alp Üçok
- Istanbul University Istanbul Faculty of Medicine, Department of Psychiatry, Turkey.
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Komossa K, Rummel‐Kluge C, Schwarz S, Schmid F, Hunger H, Kissling W, Leucht S, Cochrane Schizophrenia Group. Risperidone versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2011; 2011:CD006626. [PMID: 21249678 PMCID: PMC4167865 DOI: 10.1002/14651858.cd006626.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In many countries of the industrialised world second-generation ("atypical") antipsychotics (SGAs) have become the first line drug treatment for people with schizophrenia. The question as to whether and if so how much the effects of the various SGAs differ is a matter of debate. In this review we examined how the efficacy and tolerability of risperidone differs from that of other SGAs. OBJECTIVES To evaluate the effects of risperidone compared with other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychosis. SEARCH STRATEGY 1. Electronic searching We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.2. Reference searching We inspected the references of all identified studies for more trials.3. Personal contact We contacted the first author of each included study for missing information.4. Drug companies We contacted the manufacturers of all atypical antipsychotics included for additional data. SELECTION CRITERIA We included all randomised, blinded trials comparing oral risperidone with oral forms of amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated risk ratio (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated mean differences (MD), again based on a random-effects model. MAIN RESULTS The review currently includes 45 blinded RCTs with 7760 participants. The number of RCTs available for each comparison varied: four studies compared risperidone with amisulpride, two with aripiprazole, 11 with clozapine, 23 with olanzapine, eleven with quetiapine, two with sertindole, three with ziprasidone and none with zotepine. Attrition from these studies was high (46.9%), leaving the interpretation of results problematic. Furthermore, 60% were industry sponsored, which can be a source of bias.There were few significant differences in overall acceptability of treatment as measured by leaving the studies early. Risperidone was slightly less acceptable than olanzapine, and slightly more acceptable than ziprasidone in this regard.Risperidone improved the general mental state (PANSS total score) slightly less than olanzapine (15 RCTs, n = 2390, MD 1.94 CI 0.58 to 3.31), but slightly more than quetiapine (9 RCTs, n = 1953, MD -3.09 CI -5.16 to -1.01) and ziprasidone (3 RCTs, n = 1016, MD -3.91 CI -7.55 to -0.27). The comparisons with the other SGA drugs were equivocal. Risperidone was also less efficacious than olanzapine and clozapine in terms of leaving the studies early due to inefficacy, but more efficacious than ziprasidone in the same outcome.Risperidone produced somewhat more extrapyramidal side effects than a number of other SGAs (use of antiparkinson medication versus clozapine 6 RCTs, n = 304, RR 2.57 CI 1.47 to 4.48, NNH 6 CI 33 to 3; versus olanzapine 13 RCTs, n = 2599, RR 1.28 CI 1.06 to 1.55, NNH 17 CI 9 to 100; versus quetiapine 6 RCTs, n = 1715, RR 1.98 CI 1.16 to 3.39, NNH 20 CI 10 to 100; versus ziprasidone 2 RCTs, n = 822, RR 1.42 CI 1.03 to 1.96, NNH not estimable; parkinsonism versus sertindole 1 RCT, n = 321, RR 4.11 CI 1.44 to 11.73, NNH 14 CI 100 to 8). Risperidone also increased prolactin levels clearly more than all comparators, except for amisulpride and sertindole for which no data were available.Other adverse events were less consistently reported, but risperidone may well produce more weight gain and/or associated metabolic problems than amisulpride (weight gain: 3 RCTs, n = 585, MD 0.99 CI 0.37 to 1.61), aripiprazole (cholesterol increase: 1 RCT, n = 83, MD 22.30 CI 4.91 to 39.69) and ziprasidone (cholesterol increase 2 RCTs, n = 767, MD 8.58 CI 1.11 to 16.04) but less than clozapine (weight gain 3 RCTs n = 373, MD -3.30 CI -5.65 to -0.95), olanzapine (weight gain 13 RCTs, n = 2116, MD -2.61 CI -3.74 to -1.48), quetiapine (cholesterol increase: 5 RCTs, n = 1433, MD -8.49 CI -12. 23 to -4.75) and sertindole (weight gain: 2 RCTs, n = 328, MD -0.99 CI -1.86 to -0.12). It may be less sedating than clozapine and quetiapine, lengthen the QTc interval less than sertindole (QTc change: 2 RCTs, n = 495, MD -18.60 CI -22.37 to 14.83), produce fewer seizures than clozapine (2 RCTs, n = 354, RR 0.22 CI 0.07 to 0.70, NNT 14 CI 8 to 33) and less sexual dysfunction in men than sertindole (2 RCTs, n = 437, RR 0.34 CI 0.16 to 0.76, NNT 13 CI 8 to 33). AUTHORS' CONCLUSIONS Risperidone seems to produce somewhat more extrapyramidal side effects and clearly more prolactin increase than most other SGAs. It may also differ from other compounds in efficacy and in the occurrence of other adverse effects such as weight gain, metabolic problems, cardiac effects, sedation and seizures. Nevertheless, the large proportion of participants leaving studies early and incomplete reporting of outcomes makes it difficult to draw firm conclusions. Further large trials, especially comparing risperidone with those other new drugs for which only a few RCTs are available, are needed.
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Affiliation(s)
- Katja Komossa
- Technische Universität München, Klinikum rechts der IsarKlinik und Poliklinik für Psychosomatische und Medizin und PsychotherapieMoehlstrasse 26MünchenGermany81675
| | - Christine Rummel‐Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität LeipzigSemmelweisstr. 1004103 LeipzigGermany
| | - Sandra Schwarz
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Franziska Schmid
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Heike Hunger
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Werner Kissling
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Stefan Leucht
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
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Pallanti S, Grassi G, Sarrecchia ED, Cantisani A, Pellegrini M. Obsessive-compulsive disorder comorbidity: clinical assessment and therapeutic implications. Front Psychiatry 2011; 2:70. [PMID: 22203806 PMCID: PMC3243905 DOI: 10.3389/fpsyt.2011.00070] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/21/2011] [Indexed: 12/15/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder affecting approximately 1-3% of the population. OCD is probably an etiologically heterogeneous condition. Individuals with OCD frequently have additional psychiatric disorders concomitantly or at some time during their lifetime. Recently, some authors proposed an OCD sub-classification based on comorbidity. An important issue in assessing comorbidity is the fact that the non-response to treatment often involves the presence of comorbid conditions. Non-responsive patients are more likely to meet criteria for comorbid axis I or axis II disorders and the presence of a specific comorbid condition could be a distinguishing feature in OCD, with influence on the treatment adequacy and outcome.
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Affiliation(s)
- Stefano Pallanti
- Department of Psychiatry, Mount Sinai School of Medicine New York, NY, USA
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Obsessive-compulsive disorder and obsessive-compulsive symptoms in Japanese inpatients with chronic schizophrenia - a possible schizophrenic subtype. Psychiatry Res 2010; 179:241-6. [PMID: 20483470 DOI: 10.1016/j.psychres.2009.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 08/09/2009] [Accepted: 08/11/2009] [Indexed: 11/22/2022]
Abstract
To investigate the prevalence of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) and their association with demographic and clinical factors, 92 inpatients with chronic schizophrenia participated in this study. Demographic factors, severity of psychiatric symptoms as determined by Brief Psychiatric Rating Scale and OCS by Yale-Brown Obsessive Compulsive Scale, general functioning, extrapyramidal symptoms, and dose of antipsychotics were compared between patients with and without OCD or OCS. The Mini-International Neuropsychiatric Interview was employed for diagnosis of OCD and OCS. OCD and OCS were observed in 14.1% and 51.1% of inpatients with schizophrenia, respectively. Schizophrenic patients with OCS exhibited significantly earlier onset of schizophrenia, lower socioeconomic status, and more severe psychiatric symptoms than those without OCS. Earlier hospitalization of schizophrenia, family history of psychosis, and more severe schizophrenic symptoms were associated with comorbidity of OCS, as determined by logistic regression analysis, and younger age was associated with more severe OCS. However, negative symptoms were associated with comorbidity of OCD in chronic schizophrenia. Our findings suggest there is a subtype of schizophrenia with OCS, which is related to earlier onset and more severe psychotic symptoms.
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Obsessive-compulsive symptoms in schizophrenia: their relationship with clinical features and pharmacological treatment. J Psychiatr Pract 2010; 16:235-42. [PMID: 20644358 DOI: 10.1097/01.pra.0000386909.84289.ee] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate (1) the frequency of obsessive-compulsive symptoms (OCS) in patients with schizophrenia, (2) the impact of OCS on clinical features of schizophrenia, and (3) the association between type of antipsychotic treatment and presence of OCS. METHODS OCS were evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in 70 patients with schizophrenia. The patients were then divided into two subgroups: those with at least a moderate level of OCS and those with mild or absent OCS. The two subgroups were compared using scores on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Global Assessment of Functioning Scale (GAF). RESULTS Of the 70 patients with schizophrenia who were evaluated, 36 (51.4%) had at least moderate OCS (Y-BOCS score >16). SAPS subscale scores for hallucinations and delusions and GAF scores were found to be significantly higher among patients with at least moderate OCS, compared with those with mild or absent OCS. A significant relationship between at least moderate OCS and treatment with conventional antipsychotics was also observed. CONCLUSIONS The presence of OCS seems to have the potential to affect clinical outcomes in schizophrenia and treatment with conventional antipsychotics appears to be correlated with the presence of OCS.
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Komossa K, Rummel‐Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, Kissling W, Leucht S, Cochrane Schizophrenia Group. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2010; 2010:CD006654. [PMID: 20238348 PMCID: PMC4169107 DOI: 10.1002/14651858.cd006654.pub2] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In many countries of the industrialised world second generation ("atypical") antipsychotics have become the first line drug treatment for people with schizophrenia. The question as to whether, and if so how much, the effects of the various second generation antipsychotics differ is a matter of debate. In this review we examined how the efficacy and tolerability of olanzapine differs from that of other second generation antipsychotics. OBJECTIVES To evaluate the effects of olanzapine compared to other atypical antipsychotics for people with schizophrenia and schizophrenia-like psychosis. SEARCH STRATEGY 1. Electronic searching We searched the Cochrane Schizophrenia Group Trials Register (April 2007) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO.2. Reference searching We inspected the reference of all identified studies for more trials.3. Personal contact We contacted the first author of each included study for missing information.4. Drug companies We contacted the manufacturers of all atypical antipsychotics included for additional data. SELECTION CRITERIA We included all randomised trials that used at least single-blind (rater-blind) design, comparing oral olanzapine with oral forms of amisulpride, aripiprazole, clozapine, quetiapine, risperidone, sertindole, ziprasidone or zotepine in people with schizophrenia or schizophrenia-like psychosis. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model. MAIN RESULTS The review currently includes 50 studies and 9476 participants which provided data for six comparisons (olanzapine compared to amisulpride, aripiprazole, clozapine, quetiapine, risperidone or ziprasidone). The overall attrition from the included studies was considerable (49.2%) leaving the interpretation of results problematic.Olanzapine improved the general mental state (PANSS total score) more than aripiprazole (2 RCTs, n=794, WMD -4.96 CI -8.06 to -1.85), quetiapine (10 RCTs, n=1449, WMD -3.66 CI -5.39 to -1.93), risperidone (15 RCTs, n=2390, WMD -1.94 CI -3.31 to -0.58) and ziprasidone (4 RCTs, n=1291, WMD -8.32 CI -10.99 to -5.64), but not more than amisulpride or clozapine. This somewhat better efficacy was confirmed by fewer participants in the olanzapine groups leaving the studies early due to inefficacy of treatment compared to quetiapine (8 RCTs, n=1563, RR 0.56 CI 0.44 to 0.70, NNT 11 CI 6 to 50), risperidone (14 RCTs, n=2744, RR 0.78 CI 0.62 to 0.98, NNT 50 CI 17 to 100) and ziprasidone (5 RCTs, n=1937, RR 0.64 CI 0.51 to 0.79, NNT 17, CI 11 to 33).Fewer participants in the olanzapine group than in the quetiapine (2 RCTs, n=876, RR 0.56 CI 0.41 to 0.77, NNT 11 CI 7 to 25) and ziprasidone (2 RCTs, n=766, RR 0.65 CI 0.45 to 0.93, NNT 17 CI 9 to 100) treatment groups, but not in the clozapine group (1 RCT, n=980, RR 1.28 CI 1.02 to 1.61, NNH not estimable), had to be re-hospitalised in the trials.Except for clozapine, all comparators induced less weight gain than olanzapine (olanzapine compared to amisulpride: 3 RCTs, n=671, WMD 2.11kg CI 1.29kg to 2.94kg; aripiprazole: 1 RCT, n=90, WMD 5.60kg CI 2.15kg to 9.05kg; quetiapine: 7 RCTs, n=1173, WMD 2.68kg CI 1.10kg to 4.26kg; risperidone: 13 RCTs, n=2116, WMD 2.61kg CI 1.48kg to 3.74kg; ziprasidone: 5 RCTs, n=1659, WMD 3.82kg CI 2.96kg to 4.69kg). Associated problems such as glucose and cholesterol increase were usually also more frequent in the olanzapine group.Other differences in adverse effects were less well documented. Nevertheless, olanzapine may be associated with slightly more extrapyramidal side effects than quetiapine (use of antiparkinson medication (6 RCTs, n=1090, RR 2.05 CI 1.26 to 3.32, NNH 25 CI 14 to 100), but less than risperidone (use of antiparkinson medication 13 RCTs, n=2599, RR 0.78 CI 0.65 to 0.95, NNH 17 CI 9 to 100) and ziprasidone (use of antiparkinson medication 4 RCTs, n=1732, RR 0.70 CI 0.50 to 0.97, NNH not estimable). It may also increase prolactin somewhat more than aripiprazole, clozapine and quetiapine, but clearly less so than risperidone (6 RCTs, n=1291, WMD -22.84 CI -27.98 to -17.69). AUTHORS' CONCLUSIONS Olanzapine may be a somewhat more efficacious drug than some other second generation antipsychotic drugs. This small superiority in efficacy needs to be weighed against a larger weight gain and associated metabolic problems than most other second generation antipsychotic drugs, except clozapine. These conclusions are tentative due to the large number of people leaving the studies early which possibly limits the validity of the findings. Further large, well-designed trials are necessary to establish the relative effects of different second generation antipsychotic drugs.
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Affiliation(s)
- Katja Komossa
- Technische Universität München, Klinikum rechts der IsarKlinik und Poliklinik für Psychosomatische und Medizin und PsychotherapieMoehlstrasse 26MünchenGermany81675
| | - Christine Rummel‐Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität LeipzigSemmelweisstr. 1004103 LeipzigGermany
| | - Heike Hunger
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Franziska Schmid
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Sandra Schwarz
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Lorna Duggan
- Kneeswork House HosptialPartnership in CareBassingbournHertsUKSG8 5JP
| | - Werner Kissling
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Stefan Leucht
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
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Lee MJ, Shin YB, Sunwoo YK, Jung SH, Kim WH, Kang MH, Lee JS, Bae JN, Kim CE. Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder. Psychiatry Investig 2009; 6:286-93. [PMID: 20140127 PMCID: PMC2808798 DOI: 10.4306/pi.2009.6.4.286] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/17/2009] [Accepted: 10/27/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We investigated the neurocognitive deficits in schizophrenic patients with and without obsessive-compulsive disorder (OCD). METHODS We grouped 27 patients as either obsessive-compulsive or non-obsessive-compulsive based on the presence of OCD. The two groups completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Positive and Negative Symptom Scale (PANSS), and Hamilton Depression Scale. The intelligence quotient (IQ) was tested using the Korean Wechsler Adult Intelligence Scale. The memory quotient (MQ) was tested using the Korean-Auditory Verbal Learning and Korean-Complex Figure Test. The executive intelligence quotient (EIQ) was determined using the Kims executive intelligence test (EXIT). RESULTS Ten of the 27 patients had OCD. The compulsion score of Y-BOCS was positively correlated with positive symptoms, negative symptoms, and the total scores of PANSS. The OCD-schizophrenia patients had higher IQs. No difference was found in MQ. Although the EIQ did not differ between the two groups, the OCD-schizophrenia patients performed better at the Stroop-interference and verbal fluency tests, which was highly dependent on executive function. CONCLUSION Our findings suggest that OCD may have a protective effect on some cognitive function, at least in relatively early stage of illness. Moreover, based on clinical, neurocognitive features, schizophrenia with OCD could be considered as a distinct subtype of schizophrenia.
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Affiliation(s)
- Myung-Ji Lee
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Yong-Bum Shin
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
- Department of Psychiatry, New Hope Hospital, Incheon, Korea
| | - Young-Kyung Sunwoo
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
- Department of Psychiatry, Gyeonggi Provincial Medical Center, Uljeongbu Hospital, Uljeongbu, Korea
| | - Seung-Ho Jung
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Min-Hee Kang
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Jeong-Seop Lee
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
| | - Chul-Eung Kim
- Department of Psychiatry, Inha University College of Medicine, Incheon, Korea
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Sa AR, Hounie AG, Sampaio AS, Arrais J, Miguel EC, Elkis H. Obsessive-compulsive symptoms and disorder in patients with schizophrenia treated with clozapine or haloperidol. Compr Psychiatry 2009; 50:437-42. [PMID: 19683614 DOI: 10.1016/j.comppsych.2008.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 10/18/2008] [Accepted: 11/02/2008] [Indexed: 11/18/2022] Open
Abstract
We conducted a cross-sectional study to compare the prevalence and severity of obsessive-compulsive symptoms (OCSs) and obsessive-compulsive disorder (OCD) in patients with schizophrenia treated with clozapine or haloperidol. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders-patient edition was used to diagnose schizophrenia and OCD. Sixty subjects, 40 of them using clozapine and 20 using haloperidol, completed the Yale-Brown Obsessive-Compulsive Scale, the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression. The prevalence of OCD in patients taking clozapine was 20%, whereas the prevalence of patients taking haloperidol was 10%, although this difference was not statistically significant (P = .540). However, patients using clozapine showed higher severity of OCSs than patients using haloperidol (P = .027) did. When schizophrenia patients were divided according to the presence or absence of OCD or OCSs, patients with schizophrenia and OCD or OCSs showed higher severity of schizophrenia symptoms when compared to those with schizophrenia without OCD and OCSs (P = .002). A PANSS total score higher than 70 and the use of antidepressants were predictors of the presence of OCSs or OCD. Schizophrenia patients taking clozapine had higher severity scores both in obsessive-compulsive and schizophrenia rating scales. These results may support an association between the exacerbation of obsessive-compulsive phenomena and the use of clozapine.
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Affiliation(s)
- Antonio R Sa
- Department and Institute of Psychiatry, Clinical Hospital, Faculty of Medicine, University of São Paulo, Brazil.
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Abstract
INTRODUCTION The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia and related disorders has been increasingly recognized. However, the rate of psychosis comorbidity in OCD patients has yet to be systematically evaluated. METHODS The prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychotic disorders was evaluated in 757 subjects consecutively referred to a specialised diagnostic and treatment facility for OCD. Demographic and clinical characteristics were assessed. RESULTS Thirteen OCD patients (1.7%) also met the DSM-IV criteria for a psychotic disorder. We found no significant differences in clinical characteristic between OCD patients with and without a psychotic disorder, although patients with OCD and a psychotic disorder more likely used illicit substances and more likely were male. CONCLUSION Relatively few patients referred to a specialized treatment OCD center suffer from a psychotic disorder.
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Aripiprazole for the treatment of schizophrenia with co-occurring social anxiety: an open-label cross-taper study. J Clin Psychopharmacol 2009; 29:206-9. [PMID: 19440071 DOI: 10.1097/jcp.0b013e3181a48e12] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Co-occurring social anxiety in patients with schizophrenia is common and often severe. Pharmacologic agents with serotonin receptor 1A agonist properties such as aripiprazole are believed to be effective anxiolytic drugs. This open-label study tested the hypothesis that a switchover to aripiprazole would reduce the severity of social anxiety in patients, who have schizophrenia with co-occurring social anxiety, treated with neuroleptic medications. STUDY DESIGN Eligible consenting outpatients meeting the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for schizophrenia or schizoaffective disorder with co-occurring social anxiety symptoms completed baseline assessments, after which their neuroleptic medication was gradually cross-titrated over to a maximum of 30 mg of aripiprazole orally per day. Patients who completed the 2-month short-term study had the option to continue for 10 more months in the extension phase of the study. Complete baseline assessments were performed after 1, 2, 4, 6, 9, and 12 months. The study hypothesized that a switchover to aripiprazole would significantly improve social anxiety symptoms and quality of life ratings in the short term and that treatment continuation would help maintain and strengthen those effects, as assessed on the Liebowitz Social Anxiety and Sheehan Disability scales and on preselected specific global items of the Lehman Quality of Life Interview. RESULTS Sixteen patients were enrolled in the short-term study, and 10 of them entered the extension phase study. Last observation carried forward analysis showed significant improvements from baseline to the end of month 2 and from baseline to the end of month 12 in social anxiety scores (Liebowitz Social Anxiety Scale total, avoidance, and anxiety), social disability scores (Sheehan Disability Scale total, work, social life, and family), and in the Lehman Quality of Life Interview overall function, average life in general, and emotional well-being scores and psychosis (Positive and Negative Syndrome Scale total) scores. CONCLUSIONS These findings suggest that the switchover to aripiprazole effectively improved social anxiety, psychosis, and quality of life in patients with schizophrenia who were treated with neuroleptic medications. These improvements occurred within the first 8 weeks of treatment and persisted when treatment was continued for up to 1 year. Further studies are warranted to replicate these findings in controlled trials.
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Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety. J Affect Disord 2009; 115:376-85. [PMID: 19042026 DOI: 10.1016/j.jad.2008.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 09/25/2008] [Accepted: 10/03/2008] [Indexed: 01/12/2023]
Abstract
BACKGROUND The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder. Although second generation antipsychotics are being used with increasing frequency in bipolar patients, their anxiolytic effects have not been well studied in this population. METHODS The anxiolytic effect of risperidone 0.5-4 mg/day was tested in an 8-week, double-blind, placebo-controlled, randomized clinical trial in 111 patients with bipolar disorder and a co-occuring panic disorder or generalized anxiety disorder (GAD). The primary outcome measure was the Clinician Global Improvement-21 Anxiety scale (CGI-21 Anxiety). Secondary measures included the Hamilton Anxiety Scale (HAM-A) and the Sheehan Panic Disorder Scale. RESULTS On the last-observation-carried forward analysis of repeated measures analysis of variance (ANOVA), risperidone was not more effective than placebo for the CGI-21 Anxiety score or the other anxiety outcome measures. Risperidone was well tolerated, with only two patients withdrawing because of adverse events. LIMITATIONS The risperidone treated group had more patients with mixed states and lifetime panic disorder at randomization than the placebo group. The study was limited to 8 weeks and to individuals with bipolar and comorbid panic disorder or GAD. The results may not be applicable to risperidone as an add-on treatment to mood stabilizers, or to bipolar disorder comorbid with anxiety disorders other than panic disorder or GAD. CONCLUSIONS Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5-4 mg/day over 8 weeks of treatment. The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind, placebo-controlled studies.
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Lysaker PH, Whitney KA. Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment. Expert Rev Neurother 2009; 9:99-107. [PMID: 19102672 DOI: 10.1586/14737175.9.1.99] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Literature from the turn of the 20th Century to the present suggests that obsessive-compulsive symptoms occur among persons with schizophrenia at rates that far exceed what is found among persons not suffering from psychoses. Less clear, however, is the significance of those symptoms. Are obsessive-compulsive symptoms, for instance, related to other aspects of schizophrenia or do they represent another isolated dimension of distress? To address this issue, a review of studies is presented that explores the relationships between obsessive-compulsive symptoms; positive, negative and depressive symptoms; psychosocial dysfunction; and neurocognitive deficits. Results are interpreted as indicating that obsessive-compulsive symptoms are linked with graver impairments in psychosocial function. Regarding the relationship between obsessive-compulsive symptoms and neurocognition, results from across a broad range of studies are equivocal. A review of studies of pharmacological treatments for obsessive-compulsive symptoms has also failed to produce consistent results. While some agents have been found to lead to improvement in obsessive-compulsive symptoms, other studies suggest that these medications may exacerbate those same symptoms. In general, it appears that, at best, there are currently few effective treatments. Directions for future research are reviewed. Recommendations include the development of tailored psychological and psychopharmacological interventions, and the implementation of longitudinal studies sensitive to the possibility that there are qualitatively distinct groups of patients with schizophrenia and obsessive-compulsive symptoms.
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Affiliation(s)
- Paul H Lysaker
- The Indiana University School of Medicine, Department of Psychiatry, IN, USA.
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Hong DS, Bernstein M, Smith C, Gans H, Shaw RJ. Eosinophilic meningoencephalitis: psychiatric presentation and treatment. Int J Psychiatry Med 2009; 38:287-95. [PMID: 19069573 DOI: 10.2190/pm.38.3.e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eosinophilic meningoencephalitis (EM) is usually a self-limited neurological illness commonly accompanied by a variety of neurological symptoms. The presence of acute psychotic symptoms in EM, however, has not previously been reported, and there is no literature to guide its treatment and management. In this case report, the onset of psychotic symptoms in a hypoactive delirium and their significant improvement following the administration of atypical antipsychotics are described in a boy with EM. This case report demonstrates the efficacy and safety of antipsychotic agents during the acute phase of meningoencephalitis.
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Affiliation(s)
- David S Hong
- Stanford University School of Medicine, Palo Alto, California 94305-5719, USA
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Obsessive-compulsive symptoms in a randomized, double-blind study with olanzapine or risperidone in young patients with early psychosis. J Clin Psychopharmacol 2008; 28:214-8. [PMID: 18344733 DOI: 10.1097/jcp.0b013e318166f520] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia is relatively high. Antipsychotics have been found to influence OCS. OBJECTIVE To determine whether induction or severity of OCS differs during treatment with olanzapine or risperidone in young patients with early psychosis. METHODS One hundred twenty-two patients with a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder were randomized in a double-blind design to groups of 6 weeks' treatment with olanzapine (n = 59) or risperidone (n = 63), with a mean dose of 11.3 mg olanzapine and 3.0 mg risperidone at 6 weeks. Primary outcome measures were the mean baseline-to-endpoint change in total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS Treatment with olanzapine was associated with greater decreases in Y-BOCS total score than treatment with risperidone in total group (N = 122: -2.2 vs -0.3, z = -2.651, P < 0.01), in patients with baseline Y-BOCS total score greater than 0 (n = 58: -5.1 vs -0.4, z = -2.717, P < 0.01), and in patients with baseline Y-BOCS total score greater than 10 (n = 29: -7.1 vs -0.6, z = -2.138, P = 0.032). CONCLUSIONS In this randomized, 6-week, double-blind trial, we found a significant and clinically relevant difference in decrease in Y-BOCS scores favoring olanzapine compared with risperidone.
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Zinkstok J, van Nimwegen L, van Amelsvoort T, de Haan L, Yusuf MA, Baas F, Linszen D. Catechol-O-methyltransferase gene and obsessive-compulsive symptoms in patients with recent-onset schizophrenia: preliminary results. Psychiatry Res 2008; 157:1-8. [PMID: 17850881 DOI: 10.1016/j.psychres.2007.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 01/26/2007] [Accepted: 02/01/2007] [Indexed: 11/25/2022]
Abstract
The catechol-O-methyltransferase (COMT) gene is a candidate gene for schizophrenia because of its role in the breakdown of dopamine in the prefrontal cortex. The COMT gene contains a functional polymorphism changing enzyme activity that has been associated with some neuropsychiatric (endo)phenotypes, e.g. cognitive performance and anxiety. In this study we investigated the association between the COMT Val(158)Met polymorphism and obsessive-compulsive symptoms in patients with schizophrenia. Severity of obsessive-compulsive symptoms in 77 male patients with recent-onset schizophrenia was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the COMT Val(158)Met polymorphism was genotyped for these patients. We found a significant effect of the COMT genotype on Y-BOCS scores: the Val/Val genotype was associated with the highest Y-BOCS scores, whereas patients with the Met/Met genotype had the lowest Y-BOCS scores. Our data suggest that the COMT high-activity Val allele is associated with more obsessive-compulsive symptoms in young patients with schizophrenia. These results support the hypothesis that the COMT Val(158)Met polymorphism may be a modifier gene for the symptomatology of schizophrenia.
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Affiliation(s)
- Janneke Zinkstok
- Department of Psychiatry, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands.
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Fontenelle LF, Hasler G. The analytical epidemiology of obsessive-compulsive disorder: risk factors and correlates. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1-15. [PMID: 17689849 DOI: 10.1016/j.pnpbp.2007.06.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 06/23/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
In this qualitative systematic review, we evaluate studies of the demographic, innate, and environmental risk factors and correlates associated with the development of Obsessive-Compulsive Disorder (OCD) in epidemiological samples. We found that a significant proportion of the studies indicate that late adolescence is a period of increased vulnerability for the development of OCD; that OCD affects predominantly female adults and male children and adolescents; that those who are unmarried or abusing drugs are more likely to present with OCD; that OCD is a familial and genetic disorder, particularly when one considers symptom dimensions instead of categorical diagnosis and when the disorder begins at an early age; and that individuals with OCD from the community, like those seen in clinical settings, may be especially prone to present psychiatric conditions such as mood and anxiety disorders. Although there are plenty of data on the correlates and risk factors of OCD in epidemiological samples, more research is needed on other potential risk factors, including obstetrical and pregnancy problems, pre-morbid neurocognitive functioning, and streptococcal infections, among others.
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Affiliation(s)
- Leonardo F Fontenelle
- Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
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Abstract
INTRODUCTION Comorbid anxiety disorders are frequently encountered in psychoses and mainly assessed during the hospitalization. METHODS Comorbidity was investigated in 98 patients with schizophrenia, schizoaffective, or bipolar disorder, previously hospitalized for psychotic symptoms. Assessments, including Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale, were performed during hospitalization (t0) and subsequently in a phase of remission (t1). Comorbidity was assessed at t1 only. RESULTS One or more comorbid anxiety diagnoses were made in 46 (46.9%) patients. Of these, 15 (32.6%) received multiple anxiety diagnoses, while 31 (67.4%) single anxiety diagnoses. Schizophrenic patients had a rate of social anxiety disorder (SAD) higher (P<.05) than the others. Patients assessed with panic disorder or with obsessive-compulsive disorder at t1 showed significantly greater severity of illness at t0; patients with SAD demonstrated greater severity at t1. No significant differences in the rates of individual anxiety disorders were found in patients treated with typical or atypical antipsychotics or with both. CONCLUSION Anxiety disorders, particularly obsessive-compulsive disorder, panic disorder and SAD, seem to be frequently comorbid in remitted psychotic patients; SAD would be more prevalent in schizophrenia and might negatively impact the course of the illness.
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Fawzi MH, Fawzi MM, Khedr HH, Fawzi MM. Tobacco smoking in Egyptian schizophrenia patients with and without obsessive-compulsive symptoms. Schizophr Res 2007; 95:236-46. [PMID: 17662578 DOI: 10.1016/j.schres.2007.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 05/31/2007] [Accepted: 06/01/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nicotine dependence is common in schizophrenia patients but rare in patients with obsessive-compulsive disorder. Little is known, however, about smoking in schizophrenia patients with obsessive-compulsive symptoms (OCS) especially in a developing country, such as Egypt, that has the highest rate of tobacco consumption in the Middle East and North Africa. OBJECTIVES To test a hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without-OCS. RESULTS Out of 87 consecutive schizophrenia patients attending a psychiatric out-patients clinic in Egypt, 34 patients (39%) had significant OCS, and a smoking rate (85.3%) not significantly lower than that of patients without-OCS (90.6%). Patients were reclassified by their Fagerström's scores into 3 groups of nicotine dependence: mild (37 patients), high (21 patients) and very high (29 patients). There were no differences between these groups in terms of YBOCS scores (F=0.324; p=0.724). When comparing PANSS scores of patients, with and without-OCS, those of the former group were higher on the positive symptoms (mean=24.2 versus 20.8; p=0.002), and anxiety/depression (mean=10.8 versus 10.1; p=0.03) but lower on the negative symptoms (mean=15.0 versus 19.4; p=0.000), disorganized thoughts (mean=14.5 versus 17.5; p=0.002), and uncontrolled hostility/excitement) (mean=7.5 versus 9.5; p=0.002). However, there was no significant between-group difference in the total PANSS scores. CONCLUSIONS The high and equal rates of smoking in patients with-, and without-OCS, and the lack of difference between YBOCS scores of mild, high and very high nicotine dependence groups undermined our initial hypothesis that nicotine dependence in schizophrenia patients with-OCS is lower than in those without them. Nevertheless, the finding of a distinctive PANSS scores, may support a suggestion that OCS in schizophrenia represent a distinct subtype or dimension.
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Affiliation(s)
- Mounir H Fawzi
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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