Share This Article:

Broader Role for Antipsychotics in the Treatment of Obsessive Compulsive Disorder and Schizophrenia—A Malaysian Case Series

Abstract Full-Text HTML Download Download as PDF (Size:2492KB) PP. 289-294
DOI: 10.4236/ojpsych.2014.44035    2,623 Downloads   3,241 Views  

ABSTRACT

Obsessive compulsive disorder (OCD) and schizophrenia have been considered to be variants of the same disorder. At the advent of psychiatry, there was a distinction between neurotic, mood disorders and psychotic disorders. As perceptions and thoughts evolve in this dynamic field, there has been a paradigm shift in the way these disorders are being perceived. Of particular interest is that concerning OCD and schizophrenia. In a much anticipated and very welcomed move, DSM V has now included delusional beliefs as a specifier of OCD. However the much spoken about schizo- obsessive syndrome is yet to be explored and addressed. Recurrent and intrusive thoughts, impulses and images are key experiences seen in OCD. How we differentiate these vivid images from visual hallucination is a question yet to be answered. The following case series is an example of how difficult the boundaries between severe OCD and schizophrenia can be, and the promising usage of atypical antipsychotic in controlling obsessive compulsive symptoms. Whether untreated OCD is a significant prodromal symptom of schizophrenia, a subtype of schizophrenia or an initial indicator of various syndromes, remains to be seen, depending on environmental effects on the neuroplasticity of the mind and brain. The cases discussed will highlight the role of antipsychotics in patients diagnosed as having OCD, and gives strength to the idea that perhaps antipsychotics should be used more liberally in the treatment of OCD in schizophrenia. Here, we present a case series to show the use of atypical antipsychotics as monotherapy or augmenter in quelling obsessive-compulsive symptoms in patients who fulfilled the DSM V criteria for both schizophrenia and OCD. The efficacy of antipsychotics in reducing OCD symptoms in psychotic patients, as shown in this case series, contributes to the body of evidence that OCD and schizophrenia are really spectrum disorders with a common denominator. It is hoped that this exciting finding will lead to a paradigm shift in the usage of antipsychotics in OCD and eventually change how this disease is viewed and treated.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Francis, B. , Jambunathan, S. and Pillai, S. (2014) Broader Role for Antipsychotics in the Treatment of Obsessive Compulsive Disorder and Schizophrenia—A Malaysian Case Series. Open Journal of Psychiatry, 4, 289-294. doi: 10.4236/ojpsych.2014.44035.

References

[1] American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition.
[2] Hwang, M.Y. and Hollander, E. (1993) Schizo-Obsessive Disorders. Psychiatric Annals, 23, 396-401. http://dx.doi.org/10.3928/0048-5713-19930701-11
[3] Zohar, J. (1997) Is There Room for a New Diagnostic Subtype: The Schizo-Obsessive Subtype? CNS Spectrums, 2, 49-50.
[4] Solyom, L., DiNicola, V.F., Phil, M., Sookman, D. and Luchins, D. (1985) Is There an Obsessive Psychosis? Aetiological and Prognostic Factors of an Atypical Form of Obsessive-Compulsive Neurosis. Canadian Journal of Psychiatry, 30, 372-380.
[5] Insel, R.T. and Akiskal, H.S. (1986) Obsessive-Compulsive Disorder with Psychotic Features: A Phenomenologic Analysis. American Journal of Psychiatry, 143, 1527-1533.
[6] Bottas, A., Cooke, R.G. and Richter, M.A. (2005) Comorbidity and Pathophysiology of Obsessive-Compulsive Disorder in Schizophrenia: Is There Evidence for a Schizo-Obsessive Subtype of Schizophrenia? Journal of Psychiatry Neuroscience, 30, 187-193.
[7] Poyurovsky, M., Fuchs, C. and Weizman, A. (1999) Obsessive-Compulsive Disorder in Patients with First-Episode Schizophrenia. American Journal of Psychiatry, 156, 1998-2000.
[8] Nechmad, A., Ratzoni, G., Poyurovsky, M., Meged, S., Avidan, G., Fuchs, C., et al. (2003) Obsessive-Compulsive Disorder in Adolescent Schizophrenia Patients. American Journal of Psychiatry, 160, 1002-1004.
[9] Byerly, M., Goodman, W., Acholonu, W., Bugno, R. and Rush, A.J. (2005) Obsessive Compulsive Symptoms in Schizophrenia: Frequency and Clinical Features. Schizophrenia Research, 76, 309-316.
[10] Faragian, S., Fuchs, C., Pashinian, A., Weizman, R., Weizman, A. and Poyurovsky, M. (2012) Age-of-Onset of Schizophrenic and Obsessive-Compulsive Symptoms in Patients with Schizo-Obsessive Disorder. Psychiatry Research, 197, 19-22. http://dx.doi.org/10.1016/j.psychres.2012.02.024
[11] Van Ameringen, M., Simpson, W., Patterson, B., Dell’Osso, B., Fineberg, N., Hollander, E., et al. (2014) Pharmacological Treatment Strategies in Obsessive Compulsive Disorder: A Cross-Sectional View in Nine International OCD Centers. Journal of Psychopharmacology, 28, 596-602.
[12] McDougle, C.J., Epperson, C.N., Pelton, G.H., Wasylink, S. and Price, L.H. (2000) A Double-Blind, Placebo-Controlled Study of Risperidone Addition in Serotonin Reuptake Inhibitor-Refractory Obsessive-Compulsive Disorder. Archives of General Psychiatry, 57, 794-801.
[13] Fineberg, N.A., Gale, T.M. and Sivakumaran, T. (2007) A Review of Antipsychotics in the Treatment of Obsessive Compulsive Disorder. FOCUS, 5, 354-360.
[14] Bystritsky, A., Ackerman, D.L., Rosen, R., Vapnik, T., Gorbis, E., Maidment, K.M., et al. (2004) Augmentation of SSRI Response in Refractory Obsessive-Compulsive Disorder Using Adjunctive Olanzapine: A Placebo-Controlled Trial. The Journal of Clinical Psychiatry, 65, 565-568.
http://dx.doi.org/10.4088/JCP.v65n0418
[15] McDougle, C.J., Barr, L.C., Goodman, W.K., Pelton, G.H., Aronson, S.C., Anand, A., et al. (1995) Lack of Efficacy of Clozapine Monotherapy in Refractory Obsessive-Compulsive Disorder. American Journal of Psychiatry, 152, 1812-1814.
[16] de Haan, L., Linszen, D. and Gorsira, R. (1999) Clozapine and Obsessions in Patients with Recent-Onset Schizophrenia and Other Psychotic Disorders. The Journal of Clinical Psychiatry, 60, 364-365.
[17] Poyurovsky, M., Weizman, A. and Weizman, R. (2004) Obsessive-Compulsive Disorder in Schizophrenia: Clinical Characteristics and Treatment. CNS Drugs, 18, 989-1010.
http://dx.doi.org/10.2165/00023210-200418140-00004
[18] Meltzer, H.Y. and Huang, M. (2008) In Vivo Actions of Atypical Antipsychotic Drug on Serotonergic and Dopaminergic Systems. Progress in Brain Research, 172, 77-97. http://dx.doi.org/10.1016/S0079-6123(08)00909-6
[19] Dickel, D.E., Veenstra-Vander, W.J., Cox, N.J., Wu, X., Fischer, D.J., Etten-Lee, V.M., et al. (2006) Association Testing of the Positional and Functional Candidate Gene SLC1A1/EAAC1 in Early-Onset Obsessive-Compulsive Disorder. Archives of General Psychiatry, 63, 778-785.
http://dx.doi.org/10.1001/archpsyc.63.7.778
[20] Cai, J., Zhang, W., Yi, Z., Lu, W., Wu, Z., Chen, J., et al. (2013) Influence of Polymorphisms in Genes SLC1A1, GRIN2B and GRIK2 on Clozapine-Induced Obsessive-Compulsive Symptoms. Psychopharma-
cology, 230, 49-55.

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.