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Fortschr Neurol Psychiatr 2016; 84(11): 675-681
DOI: 10.1055/s-0042-116227
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Zwangssymptome bei chronisch erkrankten Patienten mit einer Schizophrenie unter Clozapintherapie

Obsessive-Compulsive Symptoms in a Sample of Patients with Chronic Schizophrenia Under Clozapine Treatment
S. Schreiter
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
A. Hasan
2   Klinik für Psychiatrie und Psychotherapie, LMU München
,
T. Majic
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
A. Wullschleger
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
M. Schouler-Ocak
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
F. Bermpohl
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
S. Gutwinski
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
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Publikationsverlauf

Publikationsdatum:
15. November 2016 (online)

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Zusammenfassung

Hintergrund: Patienten mit schizophrenen Erkrankungen zeigen eine erhöhte Prävalenz von Zwangssymptomen. Die antipsychotische Medikation, insbesondere Dauer und Art der Therapie, wird dabei als mögliche Ursache diskutiert.

Methode: Untersuchung der Ausprägung von Zwangssymptomen (Obsessive-Compulsive Inventory – Revised) und der Häufigkeit von Zwangsstörungen (F41.X) nach ICD-10 bei 70 Patienten mit einer schizophrenen Erkrankung (F20.X) in einem naturalistischen Querschnittsdesign. Davon befanden sich n = 26 in Behandlung mit Clozapin und n = 44 in Behandlung mit anderen Antipsychotika der zweiten Generation (SGA, Second Generation Antipsychotics). Nach Gruppen-Matching bestanden zwischen beiden Gruppen keine signifikanten Unterschiede bezüglich Alter, Geschlecht, Erkrankungs- und Behandlungsdauer mit der aktuellen antipsychotischen Substanz und Dosis (Äquivalenz).

Ergebnisse: Mit Clozapin behandelte Patienten zeigten eine signifikant höhere Frequenz von Zwangsstörungen (χ2 = 7,304, p = 0,007) sowie einen höheren Ausprägungsgrad von Zwangssymptomen (t = 2,216, p = 0,037) im Vergleich zu Patienten mit anderen SGA. Die Behandlungsdauer mit der aktuellen Substanz korrelierte signifikant (p = 0,033, r = 0,323) mit der Schwere der Zwangssymptomatik, kontrolliert für die Erkrankungsdauer für die gesamte Stichprobe. Eine signifikante Korrelation zwischen Schwere der Zwangssymptomatik und Erkrankungsdauer, kontrolliert für die Behandlungsdauer, zeigte sich hingegen nicht.

Diskussion: Unsere Ergebnisse weisen auf einen Zusammenhang zwischen der Entwicklung von Zwangssymptomen und -störungen und antipsychotischer Medikation, insbesondere mit Clozapin, hin. Dabei korreliert die Behandlungsdauer mit dem Ausprägungsgrad der Zwangssymptomatik, auch unabhängig von der Erkrankungsdauer.

Abstract

Background: There is a high prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Antipsychotic treatment, especially duration and type of substance, is suspected to increase or even cause OCS.

Methods: We examined in a naturalistic cross-sectional study the severity of OCS (Obsessive-Compulsive Inventory – Revised) and the incidence of obsessive-compulsive disorder (OCD) according to ICD-10 criteria in 70 patients with schizophrenia. 26 patients were treated with clozapine and 44 patients were treated with another second-generation antipsychotic (SGA). After group matching, the two groups did not differ significantly in age, gender, duration of illness, treatment duration with the current antipsychotic substance and chlorpromazine-equivalent dosage.

Results: Patients treated with Clozapine showed a significantly higher rate of OCD (χ2 = 7.304, p = 0.007) and a significantly higher severity of OCS (t = 2.216, p = 0.037) compared to patients treated with another SGA. For the whole sample, duration of treatment with the current antipsychotic medication correlated significantly (p = 0.033, r = 0.323) with the severity of OCS, controlled for duration of illness. However, there was no significant correlation between severity of OCS and duration of illness, controlled for duration of treatment with the current antipsychotic substance.

Discussion: Our data suggest an interrelation between the development of OCS or OCD and antipsychotic treatment, especially clozapine. Thereby, duration of treatment is correlated with the severity of OCS, irrespective of the duration of illness.

Schlüsselwörter

Schizophrenie - Zwangsstörung - Clozapin - Antipsychotika

Key words

schizophrenia - obsessive-compulsive disorder - clozapine - antipsychotics
 

  • Referenzen

  • 1 Schirmbeck F, Swetz M, de Haan L. Epidemiology: prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive-compulsive symptoms in patients with psychotic disorders. In: De Haan L, Schirmbeck F, Zink M, (eds) Obsessive-comp, n.d. 2015
    CrossrefGoogle Scholar
  • 2 Fullana MA, Mataix-Cols D, Caspi A et al. Obsessions and compulsions in the community: prevalence, interference, help-seeking, developmental stability, and co-occurring psychiatric conditions. Am J Psychiatry 2009; 166: 329-336
    CrossrefPubMedGoogle Scholar
  • 3 Fireman B, Koran LM, Leventhal JL et al. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry 2001; 158: 1904-1910
    CrossrefPubMedGoogle Scholar
  • 4 Buckley PF, Miller BJ, Lehrer DS et al. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35: 383-402
    CrossrefPubMedGoogle Scholar
  • 5 Lysaker PH, Whitney KA. Obsessive-compulsive symptoms in schizophrenia: prevalence, correlates and treatment. Expert Rev Neurother 2009; 9: 99-107
    CrossrefPubMedGoogle Scholar
  • 6 Mukhopadhaya K, Krishnaiah R, Taye T et al. Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause for clinical concern. J Psychopharmacol 2009; 23: 6-13
    CrossrefPubMedGoogle Scholar
  • 7 Poyurovsky M, Weizman A, Weizman R. Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs 2004; 18: 989-1010
    Google Scholar
  • 8 Meier SM, Petersen L, Pedersen MG et al. Obsessive-Compulsive Disorder as a Risk Factor for Schizophrenia A Nationwide Study. 2016; 71: 1215-1221
    PubMedGoogle Scholar
  • 9 Cederlöf M, Lichtenstein P, Larsson H et al. Obsessive-Compulsive Disorder, Psychosis, and Bipolarity : A Longitudinal Cohort and Multigenerational Family Study. Schizophr Bull 2015; 41: 1076-1083
    CrossrefPubMedGoogle Scholar
  • 10 Sa AR, Hounie AG, Sampaio AS et al. Obsessive-compulsive symptoms and disorder in patients with schizophrenia treated with clozapine or haloperidol. Compr Psychiatry 2009; 50: 437-442
    CrossrefPubMedGoogle Scholar
  • 11 Cunill R, Castells X, Simeon D. Relationships between obsessive-compulsive symptomatology and severity of psychosis in schizophrenia: A systematic review and meta-analysis. J Clin Psychiatry 2009; 70: 70-82
    Google Scholar
  • 12 Lysaker PH, Lancaster RS, Nees MA et al. Patterns of obsessive-compulsive symptoms and social function in schizophrenia. Psychiatry Res 2004; 125: 139-146
    CrossrefPubMedGoogle Scholar
  • 13 Ongur D, Goff DC. Obsessive-compulsive symptoms in schizophrenia: associated clinical features, cognitive function and medication status. Schizophr Res 2005; 75: 349-362
    CrossrefPubMedGoogle Scholar
  • 14 Guillem F, Satterthwaite J, Pampoulova T et al. Relationship between psychotic and obsessive compulsive symptoms in schizophrenia. Schizophr Res 2009; 115: 358-362
    CrossrefPubMedGoogle Scholar
  • 15 Mahendran R, Liew E, Subramaniam M. De novo emergence of obsessive-compulsive symptoms with atypical antipsychotics in asian patients with schizophrenia or schizoaffective disorder: a retrospective, cross-sectional study. J Clin Psychiatry 2007; 68: 542-545
    CrossrefPubMedGoogle Scholar
  • 16 Kim SW, Shin IS, Kim JM et al. The 5-HT2 receptor profiles of antipsychotics in the pathogenesis of obsessive-compulsive symptoms in schizophrenia. Clin Neuropharmacol 2009; 32: 224-226
    CrossrefPubMedGoogle Scholar
  • 17 Fonseka TM, Richter MA, Muller DJ. Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature. Curr Psychiatry Rep 2014; 16: 510
    CrossrefPubMedGoogle Scholar
  • 18 Schirmbeck F, Zink M. Clozapine-Induced Obsessive-Compulsive Symptoms in Schizophrenia: A Critical Review. Curr Neuropharmacol 2012; 10: 88-95
    Google Scholar
  • 19 Poyurovsky M, Kriss V, Weisman G et al. Comparison of clinical characteristics and comorbidity in schizophrenia patients with and without obsessive-compulsive disorder: schizophrenic and OC symptoms in schizophrenia. J Clin Psychiatry 2003; 64: 1300-1307
    CrossrefPubMedGoogle Scholar
  • 20 Reznik I, Mester R, Kotler M et al. Obsessive-compulsive schizophrenia: a new diagnostic entity?. J Neuropsychiatry Clin Neurosci 2001; 13: 115-116
    CrossrefPubMedGoogle Scholar
  • 21 Bottas A, Cooke RG, Richter MA. Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: is there evidence for a schizo-obsessive subtype of schizophrenia?. J Psychiatry Neurosci 2005; 30: 187-193
    PubMedGoogle Scholar
  • 22 Patel DD, Laws KR, Padhi A et al. The neuropsychology of the schizo-obsessive subtype of schizophrenia: a new analysis. Psychol Med 2010; 40: 921-933
    Google Scholar
  • 23 van Nimwegen L, de Haan L, van Beveren N et al. Obsessive-compulsive symptoms in a randomized, double-blind study with olanzapine or risperidone in young patients with early psychosis. J Clin Psychopharmacol 2008; 28: 214-218
    CrossrefPubMedGoogle Scholar
  • 24 Lim M, Park DY, Kwon JS et al. Prevalence and Clinical Characteristics of Obsessive-Compulsive Symptoms Associated With Atypical Antipsychotics. J Clin Psychopharmacol 2007; 27: 712-713
    CrossrefPubMedGoogle Scholar
  • 25 Grassi G, Poli L, Cantisani A et al. Hypochondriasis and obsessive-compulsive disorder in schizophrenic patients treated with clozapine vs other atypical antipsychotics. CNS Spectr 2014; 19: 340-346
    CrossrefPubMedGoogle Scholar
  • 26 Ertugrul A, Anil Yagcioglu A, Eni N et al. Obsessive-compulsive symptoms in clozapine-treated schizophrenic patients. Psychiatry Clin Neurosci 2005; 59: 219-222
    CrossrefPubMedGoogle Scholar
  • 27 De Haan L, Oekeneva A, Amelsvoort T et al. Obsessive–compulsive disorder and treatment with clozapine in 200 patients with recent-onset schizophrenia or related disorders. Eur Psychiatry 2004; 19: 523-524
    CrossrefPubMedGoogle Scholar
  • 28 Schirmbeck F, Esslinger C, Rausch F et al. Antiserotonergic antipsychotics are associated with obsessive – compulsive symptoms in schizophrenia. Psychol Med 2011; 2361-2373
    PubMedGoogle Scholar
  • 29 Scheltema Beduin AA. Obsessive-Compulsive Symptoms in Patients With Schizophrenia: A Naturalistic Cross-Sectional Study Comparing Treatment With Clozapine, Olanzapine, Risperidone, and No Antipsychotics in 543 Patients. J Clin Psychiatry 2012; 1395-1402
    PubMedGoogle Scholar
  • 30 De Haan L, Sterk B, Wouters L et al. The 5-Year Course of Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder in First-Episode Schizophrenia and Related Disorders. 2013; 39: 151-160
    PubMedGoogle Scholar
  • 31 Schirmbeck F, Rausch F, Englisch S et al. Differential effects of antipsychotic agents on obsessive – compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol 2015; 27: 349-357
    PubMedGoogle Scholar
  • 32 Schirmbeck F, Rausch F, Englisch S et al. Stable Cognitive Deficits in Schizophrenia Patients With Comorbid Obsessive-Compulsive Symptoms : A 12-Month Longitudinal Study. 2013; 39: 1261-1271
    PubMedGoogle Scholar
  • 33 Gardner DM, Murphy AL, O’Donnell H et al. International consensus study of antipsychotic dosing. Am J Psychiatry 2010; 167: 686-693
    Google Scholar
  • 34 Graubner B. ICD-10-GM (internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme). Deutscher Ärzteverlag 2013;
    PubMedGoogle Scholar
  • 35 Foa EB, Huppert JD, Leiberg S et al. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess 2002; 14: 485-496
    CrossrefPubMedGoogle Scholar
  • 36 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-276
    Google Scholar
  • 37 Abramowitz JS, Deacon BJ. Psychometric properties and construct validity of the Obsessive–Compulsive Inventory—Revised: Replication and extension with a clinical sample. J Anxiety Disord 2006; 20: 1016-1035
    CrossrefPubMedGoogle Scholar
  • 38 Solem S, Hjemdal O, Vogel PA et al. A Norwegian version of the Obsessive-Compulsive Inventory-Revised: Psychometric properties. Scand J Psychol 2010; 51: 509-516
    CrossrefPubMedGoogle Scholar
  • 39 Chasson GS, Tang S, Gray B et al. Further validation of a Chinese version of the Obsessive-Compulsive Inventory-Revised. Behav Cogn Psychother 2013; 41: 249-254
    CrossrefPubMedGoogle Scholar
  • 40 Lin S, Su S, Pan C. Higher Plasma Drug Concentration in Clozapine-treated Schizophrenic Patients With Side Effects of Obsessive / Compulsive Symptoms. 2006; 28: 303-307
    PubMedGoogle Scholar
  • 41 Berman I, Merson A, Viegner B et al. Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study. J Nerv Ment Dis 1998; 186: 150-156
    CrossrefPubMedGoogle Scholar
  • 42 Kumbhani SR, Roth RM, Kruck CL et al. Non-Clinical Obsessive Compulsive Symptoms and Executive Functions in Schizophrenia. J Neuropsychiatry Clin Neurosci 2014; 22: 304-312
    PubMedGoogle Scholar
  • 43 Lysaker PH, Whitney KA, Davis LW. Associations of Executive FunctionWith Concurrent and Prospective Reports of Obsessive-Compulsive Symptoms in Schizophrenia. J Neuropsychiatry Clin Neurosci 2009; 21: 38-42
    CrossrefPubMedGoogle Scholar
  • 44 Hwang MY, Morgan JE, Ph D et al. Clinical and Neuropsychological Profiles of Obsessive-Compulsive Schizophrenia : A Pilot Study. J Neuropsychiatry Clin Neurosci 2000; 12: 91-94
    CrossrefPubMedGoogle Scholar
  • 45 Lysaker PH, Ph D, Bryson GJ et al. Association of Obsessions and Compulsions in Negative Symptoms. J Neuropsychiatry Clin Neurosci 2002; 14: 449-453
    CrossrefPubMedGoogle Scholar
  • 46 Meijer JH, Swets M, Keeman S et al. 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: 30-35
    CrossrefPubMedGoogle Scholar
  • 47 Hermesh H, Weizman A, Gur S et al. Alternation learning in OCD/schizophrenia patients. Eur Neuropsychopharmacol 2003; 13: 87-91
    CrossrefPubMedGoogle Scholar
  • 48 Tumkaya S, Karadag F, Oguzhanoglu NK et al. Schizophrenia with obsessive-compulsive disorder and obsessive-compulsive disorder with poor insight : A neuropsychological comparison. Psychiatry Res 2009; 165: 38-46
    CrossrefPubMedGoogle Scholar
  • 49 Tiryaki A, Ozkorumak E. Do the obsessive-compulsive symptoms have an effect in schizophrenia?. Compr Psychiatry 2010; 51: 357-362
    CrossrefPubMedGoogle Scholar
  • 50 Whitney KA, Fastenau PS, Evans JD et al. Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms. Schizophr Res 2004; 69: 75-83
    CrossrefPubMedGoogle Scholar
  • 51 Achim AM, Maziade M, Raymond E et al. How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 2011; 37: 811-821
    Google Scholar
  • 52 Borkowska A, Pilaczynska E, Rybakowski JK. The Frontal Lobe Neuropsychological Tests in Patients With Schizophrenia and / or Obsessive-Compulsive Disorder. J Neuropsychiatry Clin Neurosci 2003; 15: 359-362
    CrossrefPubMedGoogle Scholar
  • 53 Lee MJ, Shin YB, Sunwoo YK et al. Comparative Analysis of Cognitive Function in Schizophrenia with and without Obsessive Compulsive Disorder. Psychiatry Investig 2009; 6: 286-293
    CrossrefPubMedGoogle Scholar
  • 54 Button KS, Ioannidis JPA, Mokrysz C et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 2013; 14: 365-376
    CrossrefPubMedGoogle Scholar
  • 55 Doyle M, Chorcorain AN, Griffith E et al. Obsessive compulsive symptoms in patients with Schizophrenia on Clozapine and with Obsessive Compulsive disorder: A comparison study. Compr Psychiatry 2014; 55: 130-136
    CrossrefPubMedGoogle Scholar