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Hypochondriasis and obsessive-compulsive disorder in schizophrenic patients treated with clozapine vs other atypical antipsychotics

Published online by Cambridge University Press:  01 November 2013

Giacomo Grassi ,
Lorenzo Poli ,
Andrea Cantisani ,
Lorenzo Righi ,
Gabriella Ferrari  and
Stefano Pallanti
Giacomo Grassi*
Affiliation:
Department of Neuroscience, University of Florence, AOU Careggi, Florence, Italy
Lorenzo Poli
Affiliation:
Department of Neuroscience, University of Florence, AOU Careggi, Florence, Italy
Andrea Cantisani
Affiliation:
Department of Neuroscience, University of Florence, AOU Careggi, Florence, Italy
Lorenzo Righi
Affiliation:
Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
Gabriella Ferrari
Affiliation:
Department of Neuroscience, University of Florence, AOU Careggi, Florence, Italy
Stefano Pallanti
Affiliation:
Department of Neuroscience, University of Florence, AOU Careggi, Florence, Italy
*
*Address for correspondence: Giacomo Grassi, MD, Department of Neuroscience, University of Florence, AOU Careggi, Via delle Gore 2H, 50134, Florence, Italy. (Email: [email protected])
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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.

Keywords

Atypical antipsychoticsclozapinehealth anxietyhypochondriasisobsessive-compulsive disorderschizophrenia
Type
Original Research
Information
CNS Spectrums , Volume 19 , Issue 4 , August 2014 , pp. 340 - 346
Copyright
Copyright © Cambridge University Press 2013 

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References

1.Achim, AM, Maziade, M, Raymond, E, etal. How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull. 2011; 37(4): 811–821.Google Scholar
2.Tranulis, C, Potvin, S, Gourgue, M, etal. The paradox of quetiapine in obsessive-compulsive disorder. CNS Spectr. 2005; 10(5): 356–361.Google Scholar
3.Schirmbeck, F, Zink, M. Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review. Curr Neuropharmacol. 2012; 10(1): 88–95.Google Scholar
4.Cunill, R, Castells, X, Simeon, D. Relationship between obsessive-compulsive symptomatology and severity of psychosis in schizophrenia: a systematic review and meta-analysis. J Clin Psychiatry. 2009; 70(1): 70–82.CrossRefGoogle ScholarPubMed
5.Mukhopadhaya, K, Krishnaiah, R, Taye, T, etal. Obsessive-compulsive disorder in UK clozapine-treated schizophrenia and schizoaffective disorder: a cause of clinical concern. J Psychopharmacol. 2009; 23(1): 6–13.Google Scholar
6.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(5): 400–405.Google Scholar
7.Zink, M, Knopf, U, Kuwilsky, A. Management of clozapine-induced obsessive-compulsive symptoms in a man with schizophrenia. Aust N Z J Psychiatry. 2007; 41(3): 293–294.Google Scholar
8.Lim, M, Park, DY, Kwon, JS, Joo, YH, Hong, KS. Prevalence and clinical characteristics of obsessive-compulsive symptoms associated with atypical antipsychotics. J Clin Psychopharmacol. 2007; 27(6): 712–713.Google Scholar
9.deHaan, L, Sterk, B, Wouters, L, Linszen, DH. The 5-years course of obsessive-compulsive symptoms and obsessive-compulsive disorder in first-episode schizophrenia and related disorders. Schizophr Bull. 2013; 39(1): 151–160.Google Scholar
10.Hwang, MY, Kim, SW, Yum, SY, Opler, LA. Management of schizophrenia with obsessive-compulsive features. Psychiatr Clin North Am. 2009; 32(4): 835–851.CrossRefGoogle ScholarPubMed
11.Lykouras, L, Alevizos, B, Michalopoulou, P, Rabavilas, A. Obsessive-compulsive symptoms induced by atypical antipsychotics: a review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27(3): 333–346.CrossRefGoogle ScholarPubMed
12.Alevizos, B, Papageorgiou, C, Christodoulou, GN. Obsessive-compulsive symptoms with olanzapine. Int J Neuropsychopharmacol. 2004; 7(3): 375–377.Google Scholar
13.Ke, CL, Yen, CF, Chen, CC, etal. Obsessive-compulsive symptoms associated with clozapine and risperidone treatment: three case reports and review of the literature. Kaohsiung J Med Sci. 2004; 20(6): 295–301.Google Scholar
14.Ozer, S, Arsava, M, Ertugrul, A, Demir, B. Obsessive compulsive symptoms associated with quetiapine treatment in a schizophrenic patient: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2006; 30(4): 724–727.Google Scholar
15.Stamouli, S, Lykouras, L. Quetiapine-induced obsessive-compulsive symptoms: a series of five cases. J Clin Psychopharmacol. 2006; 26(4): 396–400.Google Scholar
16.Baker, RW, Chengappa, KN, Baird, JW, etal. Emergence of obsessive compulsive symptoms during treatment with clozapine. J Clin Psychiatry. 1992; 53(12): 439–442.Google Scholar
17.deHaan, L, Linszen, DH, Gorsira, R. Clozapine and obsessions in patients with recent onset schizophrenia and other psychotic disorders. J Clin Psychiatry. 1999; 60(6): 364–365.Google Scholar
18.Ertugrul, A, Anil Yagcioglu, AE, Eni, N, Yazici, KM. Obsessive-compulsive symptoms in clozapine-treated schizophrenic patients. Psychiatry Clin Neurosci. 2005; 59(2): 219–222.Google Scholar
19.Mahendra, 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(4): 542–545.Google Scholar
20.Sa, AR, Hounie, AG, Sampaio, AS, etal. Obsessive-compulsive symptoms and disorder in patients with schizophrenia treated with clozapine or haloperidol. Compr Psychiatry. 2009; 50(5): 437–442.Google Scholar
21.deHaan, L, Oekeneva, A, Van Amelsvoort, T, Linszen, D. Obsessive-compulsive disorder and treatment with clozapine in 200 patients with recent-onset schizophrenia or related disorders. Eur Psychiatry. 2004; 19(8): 524.Google Scholar
22.Poyurovsky, M, Weizman, A, Weizman, R. Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs. 2004; 18(14): 989–1010.Google Scholar
23.Schirmbeck, F, Esslinger, C, Rausch, F, etal. Antiserotonergic antipsychotics are associated with obsessive-compulsive symptoms in schizophrenia. Psychol Med. 2011; 41(11): 2361–2373.CrossRefGoogle ScholarPubMed
24.Schirmbeck, F, Rausch, F, Englisch, S, etal. Differential effects of antipsychotics agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol. 2013; 27(4): 349–357.Google Scholar
25.Tanahashi, S, Yamamura, S, Nakagawa, M, Motomura, E, Okada, M. Clozapine, but not haloperidol, enhances glial D-serine and L-glutamate release in rat frontal cortex and primary cultured astrocytes. Br J Pharmacol. 2012; 165(5): 1543–1555.Google Scholar
26.Pallanti, S, Grassi, G, Cantisani, A. Approaches to treatment resistance. In: Zohar J, ed. Obsessive-Compulsive Disorder: Current Science and Clinical Practice. Hoboken, NJ: John Wiley & Sons; 2012; 99–134.Google Scholar
27.Kwon, JS, Joo, YH, Nam, HJ, etal. Association of the glutamate transporter gene SLC1A1 with atypical antipsychotics-induced obsessive-compulsive symptoms. Arch Gen Psychiatry. 2009; 66(11): 1233–1241.Google Scholar
28.Schirmbeck, F, Nieratschker, V, Frank, J, etal. Polymorphisms in the glutamate transporter gene SLC1A1 and obsessive-compulsive symptoms induced by second-generation antipsychotic agents. Psychiatr Genet. 2012; 22(5): 245–252.Google Scholar
29.Cai, J, Zhang, W, Yi, Z, etal. Influence of polymorphism in genes SLC1A1, GRIN2B, and GRIK2 on clozapine-induced obsessive-compulsive symptoms. Psychopharmacology (Berl). 230(1): 49–55.Google Scholar
30.Poyurovsky, M, Fuchs, C, Faragian, S, etal. Preferential aggregation of obsessive-compulsive spectrum disorders in schizophrenia patients with obsessive-compulsive disorder. Can J Psychiatry. 2006; 51(12): 746–754.Google Scholar
31.Bienvenu, OJ, Samuels, JF, Wuliek, LA, etal. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. 2012; 42(1): 1–13.Google Scholar
32.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
33.First, MB, Spritzer, RL, Gibbon, M, Willians, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders. Patient Edition (Version 2.0). Biometric Research Department. New York: New York State Psychiatric Institute; 1995.Google Scholar
34.Kay, SR, Fiszbein, A, Opler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(2): 261–276.Google Scholar
35.Montogomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134(4): 382–389.CrossRefGoogle Scholar
36.Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32(1): 50–55.Google Scholar
37.Goodman, W, Price, L, Rasmussen, S, etal. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), part I: development, use, and reliability. Arch Gen Psychiatry. 1989; 46: 1006–1011.Google Scholar
38.Goodman, W, Price, L, Rasmussen, S, etal. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), part II: validity. Arch Gen Psychiatry. 1989; 46(11): 1012–1016.Google Scholar
39.Greeven, A, Spinhoven, P, van Balkom, AJ. Hypochondriasis Y-BOCS: a study of the psychometric properties of a clinician-administered semi-structured interview to assess hypochondriacal thoughts and behaviours. Clin Psychol Psychother. 2009; 16(5): 431–443.Google Scholar
40.Hall, RC. Global assessment of functioning: a modified scale. Psychosomatics. 1995; 36(3): 267–275.Google Scholar
41.Starcevic, V. Hypochondriasis and health anxiety: conceptual challenges. Br J Psychiatry. 2013; 202(1): 7–8.Google Scholar
42.Hiller, W, Fichter, MM. High utilizers of medical care: a crucial subgroup among somatizing patients. J Psychosom Res. 2004; 56(4): 437–443.Google Scholar
43.deHaan, L, Beuk, N, Hoogenboom, B, Dingemans, P, Linszen, D. Obsessive-compulsive symptoms during treatment with olanzapine and risperidone: a prospective study of 113 patients with recent-onset schizophrenia or related disorders. J Clin Psychiatry. 2002; 63(2): 104–107.Google Scholar