6 Practical Tips for Treating Schizophrenia Comorbid With Obsessive-Compulsive Disorder

6 Practical Tips for Treating Schizophrenia Comorbid With Obsessive-Compulsive Disorder


• Obsessive-compulsive disorder (OCD) with poor insight should be considered a severe form of OCD and not be mistaken for a primary psychotic disorder; a careful history is required to ascertain for insight in previous OCD exacerbations

• OCD with poor insight may respond to treatment with an SSRI without the addition of an adjunctive antipsychotic, or preferentially to adjunctive antipsychotic added to an SSRI ; because some individuals with OCD take longer to respond to SSRIs, a therapeutic trial of an SSRI at optimized dosages for at least 8 to 12 weeks should be tried before the addition of adjunctive antipsychotic medication

• Primary OCD should be distinguished from de novo obsessive-compulsive sympoms (OCS) induced by atypical antipsychotics/serotonin-dopamine antagonists (SDAs); this highlights the importance of a careful history rather than mere cross-sectional examination

• Persons with schizophrenia should be evaluated for OCS/OCD before starting or switching to an SDA and monitored prospectively for the emergence of de novo OCS

• SDA-induced OCS may be dose-dependent; in managing treatment emergent OCS, whether to reduce the SGA dose, switch to a different antipsychotic, or continue the atypical antipsychotic and treat the de novo OCS is a matter of clinical judgment; the decision should entail a risk/benefit analysis that considers the degree of antipsychotic response to the SGA and the severity of treatment emergent OCS, among other factors

• As with pure OCD, OCD comorbid with schizophrenia may respond to treatment with an SSRI and/or adjunctive cognitive-behavioral therapy; first-line treatment for patients who meet criteria for both disorders consists of an antipsychotic and an SSRI

For more on this topic, please see "Comorbidity: Schizophrenia With Obsessive-Compulsive Disorder," by Alexandra Bottas, MD, from which this Tipsheet was adapted.

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Further reading:
Koran LM, Hanna GL, Hollander E, et al, for the American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(Suppl 7):5-53.

Chiao-Li K, Cheng-Fang Y, Cheng-Chung C, et al. Obsessive-compulsive symptoms associated with clozapine and resperidone treatment: three case reports and review of the literature. Kaohsiung J Med Sci. 2004;20:295-301.



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