Obsessive-compulsive symptoms in clozapine-treated patients take a toll on their wellbeing

Obsessive-compulsive symptoms (OCS) appear to frequently occur among schizophrenic patients receiving treatment with clozapine, and these symptoms exert a negative effect on the patients’ wellbeing, a study reports.

Researchers used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine. The patients were evaluated annually for OCS, wellbeing, general functioning, and psychopathology using standardized scales as part of routine clinical practice.

A total of 184 patients (mean age 45.9 years, 79.9 percent men, mean age on the first episode of psychosis 22.8 years) were included in the study, with a total of 527 assessments in which the Obsessive–Compulsive Inventory–Revised (OCI-R), Short Warwick–Edinburgh Mental Wellbeing Scale, and Global Assessment of Functioning Scale were completed on the same day.

The mean duration of clozapine treatment was 16.31 years, with a mean dose of 318.0 mg/day. The cohort had a mean OCI-R total score of 18.95, with 41 percent of OCI-R scales scoring ≥21 points, which is typically the threshold used to indicate obsessive-compulsive disorder.

In different linear mixed models, OCS in clozapine-treated patients was associated with significantly worse wellbeing scores. This association was independent of depression and psychotic symptoms, although OCS did not impair general functioning.

The negative impact of OCS on wellbeing was driven by obsessional thinking and hoarding behaviour, but not compulsions. The researchers pointed out that this may be attributable to the ego-syntonic nature of the compulsions.

The findings highlight the importance of routine assessment and treatment of OCS in patients with schizophrenia who are taking clozapine.