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Antiserotonergic antipsychotics are associated with obsessive–compulsive symptoms in schizophrenia

Published online by Cambridge University Press:  05 April 2011

F. Schirmbeck ,
C. Esslinger ,
F. Rausch ,
S. Englisch ,
A. Meyer-Lindenberg  and
M. Zink
F. Schirmbeck
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
C. Esslinger
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
F. Rausch
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
S. Englisch
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
A. Meyer-Lindenberg
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
M. Zink*
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
*
*Address for correspondence: M. Zink, M.D., Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, PO Box 12 21 20, D-68072 Mannheim, Germany. (Email: mathias.zink@zi-mannheim.de)
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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.

Keywords

Antipsychoticclozapinecompulsiveobsessiveschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 11 , November 2011 , pp. 2361 - 2373
Copyright
Copyright © Cambridge University Press 2011

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