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Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole.
Clin Neuropharmacol. 2009 Jul-Aug; 32(4):227-9.CN

Abstract

Patients with schizophrenia often experience comorbid obsessive-compulsive syndromes (OCSs). Within these patients, a significant subgroup developed secondary OCS during treatment with antiserotonergic, atypical antipsychotic agents such as clozapine. Although cognitive behavioral therapy and antiobsessive antidepressants brought up inconsistent results, in some cases, dose reductions of clozapine in combination approaches were able to alleviate OCS. One suggestive agent for antiobsessive add-on treatment is aripiprazole, a partial agonist at dopamine and serotonin receptors.Here, we summarize the courses of 7 patients (6 men; mean age, 37 years; mean duration of psychotic illness, 17 years). They had been treated with clozapine for 9 years. The distressing and treatment-resistant comorbidity with OCS emerged approximately 4 years after the start of clozapine therapy. During combined treatment with mean doses of 22.9 mg of aripiprazole for 9.7 weeks, we assessed a small yet statistically not significant improvement of the psychotic disorder, whereas a marked reduction of obsessions and significant improvements of compulsions could be observed. The mean total Yale Brown Obsessive Compulsive Rating Scale decreased from 18.7 to 12.4 (P = 0.003).These data support the findings of 2 previous case reports and point toward an antiobsessive potency of aripiprazole. The relevant disabling comorbidities of psychosis and OCS need further investigation with multimodal neurobiological approaches. The proposed strategy should be further evaluated in prospective controlled trials with severity of comorbid OCS as a primary end point.

Authors+Show Affiliations

Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19644230

Citation

Englisch, Susanne, et al. "Clozapine-induced Obsessive-compulsive Syndromes Improve in Combination With Aripiprazole." Clinical Neuropharmacology, vol. 32, no. 4, 2009, pp. 227-9.
Englisch S, Esslinger C, Inta D, et al. Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole. Clin Neuropharmacol. 2009;32(4):227-9.
Englisch, S., Esslinger, C., Inta, D., Weinbrenner, A., Peus, V., Gutschalk, A., Schirmbeck, F., & Zink, M. (2009). Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole. Clinical Neuropharmacology, 32(4), 227-9. https://doi.org/10.1097/WNF.0b013e31819cc8e6
Englisch S, et al. Clozapine-induced Obsessive-compulsive Syndromes Improve in Combination With Aripiprazole. Clin Neuropharmacol. 2009 Jul-Aug;32(4):227-9. PubMed PMID: 19644230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole. AU - Englisch,Susanne, AU - Esslinger,Christine, AU - Inta,Dragos, AU - Weinbrenner,Andrea, AU - Peus,Verena, AU - Gutschalk,Alexander, AU - Schirmbeck,Frederike, AU - Zink,Mathias, PY - 2009/8/1/entrez PY - 2009/8/1/pubmed PY - 2009/10/9/medline SP - 227 EP - 9 JF - Clinical neuropharmacology JO - Clin Neuropharmacol VL - 32 IS - 4 N2 - Patients with schizophrenia often experience comorbid obsessive-compulsive syndromes (OCSs). Within these patients, a significant subgroup developed secondary OCS during treatment with antiserotonergic, atypical antipsychotic agents such as clozapine. Although cognitive behavioral therapy and antiobsessive antidepressants brought up inconsistent results, in some cases, dose reductions of clozapine in combination approaches were able to alleviate OCS. One suggestive agent for antiobsessive add-on treatment is aripiprazole, a partial agonist at dopamine and serotonin receptors.Here, we summarize the courses of 7 patients (6 men; mean age, 37 years; mean duration of psychotic illness, 17 years). They had been treated with clozapine for 9 years. The distressing and treatment-resistant comorbidity with OCS emerged approximately 4 years after the start of clozapine therapy. During combined treatment with mean doses of 22.9 mg of aripiprazole for 9.7 weeks, we assessed a small yet statistically not significant improvement of the psychotic disorder, whereas a marked reduction of obsessions and significant improvements of compulsions could be observed. The mean total Yale Brown Obsessive Compulsive Rating Scale decreased from 18.7 to 12.4 (P = 0.003).These data support the findings of 2 previous case reports and point toward an antiobsessive potency of aripiprazole. The relevant disabling comorbidities of psychosis and OCS need further investigation with multimodal neurobiological approaches. The proposed strategy should be further evaluated in prospective controlled trials with severity of comorbid OCS as a primary end point. SN - 1537-162X UR - https://www.unboundmedicine.com/medline/citation/19644230/Clozapine_induced_obsessive_compulsive_syndromes_improve_in_combination_with_aripiprazole_ L2 - http://dx.doi.org/10.1097/WNF.0b013e31819cc8e6 DB - PRIME DP - Unbound Medicine ER -