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S062-3

Antipsychotics-Associated Obsessive-Compulsive Symptoms in Patients with
Schizophrenia

Sung-Wan Kim

Chonnam National University, Korea

Background/Objective: The obsessive-compulsive symptoms (OCS) are common comorbid
condition in patients with schizophrenia. OCS in schizophrenia has more than one pathogenesis, with
distinct mechanisms that may require different treatment interventions.

Method: First, OCS may occur as a prodrome preceding the onset of schizophrenia that may resolve
or attenuate after the onset of psychosis. In contrast, OCS that predates onset of schizophrenia may
persist regardless of progress in schizophrenic illness as an independent, coexisting disorder. In some
patients, OCS develops as a part of an active psychotic process that emerges along with acute
psychosis and usually resolves with the overall improvement in psychosis. As the psychotic
symptoms become attenuated, the OCS may present as obsessive ruminations or obsessive doubts,
which may eventually resolve. Finally, OCS may be developed or exacerbated following treatment
with atypical antipsychotics that possess a potent anti-serotonergic receptor profile.

Result: Therefore, the management of OCS in patients with schizophrenia requires an individualized
treatment approach based on the pathogenesis and clinical status of the patient. Anti-dopaminergic
typical antipsychotics, aripiprazole or amisulpride, may be effective for the management of OCS in
patient with schizophrenia. Adjunctive antidepressants, including escitalopram, have been found to
be effective for OCS in schizophrenia, with careful considerations for its potential pharmacokinetic
interactions with adjunct antipsychotic medications. Cognitive-behavioral therapy, such as exposure
and response prevention, can also be used to manage OCS in patients unresponsive to
pharmacological interventions.

Conclusion: A greater understanding of the pathogenesis and the development of individualized
treatment strategies for OCS will improve clinical courses and optimize outcomes.

Reference: Kim SW, Lindenmayer JP, Hwang MY. Schizophrenia with Obsessive-Compulsive
Symptoms: Clinical and Conceptual Issues. Psychiatric Annals 2013;43:442-5.
Kim SW, Jeong BO, Kim JM, et al. Associations of obsessive–compulsive symptoms with clinical
and neurocognitive features in schizophrenia according to stage of illness. Psychiatry Res 2015
(Epub ahead)