Psychopharmacology Tips

Hwang et al. (2005) makes several tentative recommendations about the pharmacotherapy of obsessive compulsive (OC) symptoms in schizophrenia patients.

1. Treatment of OC symptoms in schizophrenia with an additional medication should be considered once the patients are otherwise psychiatrically stable on a maintenance antipsychotic regimen. Though use of adjunctive antidepressants in patients with chronic schizophrenia in partial remission appears to be safe, there is some evidence that administering antidepressant agents in acutely psychotic schizophrenic patients may increase the risk of symptom exacerbation.
2. Anti-OCD agents should be prudently selected after careful pharmacologic considerations and after monitoring the patient’s therapeutic and adverse effect profiles. The ability of many of these compounds to induce or exacerbate agitation or akathisia, and the additional anticholinergic side effects that are common with both clomipramine and SSRIs are of particular concern. Furthermore, some SSRIs may increase the blood levels of some antipsychotics by as much as 25% to 30%, potentially resulting in an even greater increase inside effects. Therefore, clinicians must carefully monitor for potential new adverse effects due to pharmacokinetic drug-drug interactions.
3. Patients taking clozapine should be carefully assessed to determine if their OC symptoms preceded the initiation of clozapine therapy. If the OC symptoms appear to have started or worsened with the advent of clozapine treatment, clinicians should consider switching to another atypical antipsychotic after weighing the benefits derived from clozapine against the morbidity caused by an increase in OC symptoms. If clozapine is to be continued, an SSRI might be the anti-obsessional treatment of choice, given the significant adverse effects associated with combined clozapine and clomipramine regimen.

Ref: - Hwang, M., Yum, S.Y., Kwon, J.S., et al. (2005) Management of schizophrenia with obsessive-compulsive disorder. Psychiatric Annals, 35, 1, 36-43.