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Obsessive–compulsive symptoms in schizophrenia: a review

Published online by Cambridge University Press:  18 December 2018

Sandeep Grover*
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Swapnajeet Sahoo
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Indu Surendran
Affiliation:
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
*
Author for correspondence: Dr. Sandeep Grover, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India. Tel: +91 172 275 6807; Fax: +91 172 2744401; +91 172 274 5078; E-mail: drsandeepg2002@yahoo.com

Abstract

Objective

To review the available literature on obsessive–compulsive symptom (OCS)/obsessive–compulsive disorder (OCD) in patients with schizophrenia.

Methodology

Electronic searches were carried out to locate studies reporting various aspects of OCS/OCD in patients with schizophrenia.

Results

Available evidence suggests that prevalence of OCS/OCD in patients with schizophrenia is much higher than prevalence in general population and it is seen in all the stages of schizophrenia, starting from at risk mental state to chronic/stabilisation/deficit phases. Symptom profile of OCS/OCD in schizophrenia is similar to that seen in patients with OCD only. Presence of OCS/OCD is associated with higher severity of symptoms of schizophrenia and more negative outcome. At present there is very limited data on the efficacy/effectiveness of various pharmacological measures and psychological interventions, for management of OCS/OCD in patients with schizophrenia. There is some evidence pointing towards beneficial effect of certain antipsychotics, antidepressants and cognitive behaviour therapy. Management of OCS/OCD in patients with schizophrenia involves proper assessment. If the OCS/OCD is related to use of particular antipsychotic use, initial attempt must be made to reduce the dose of antipsychotics, however, if this is not effective, than addition of a selective serotonin reuptake inhibitor (SSRIs) must be considered. If the OCS/OCD is not related to the use of antipsychotic medication, than depending up on the severity of psychotic symptoms, addition of SSRIs must be considered.

Conclusion

This review suggests that OCS/OCD is highly prevalent among patients with schizophrenia and there is limited good quality evidence to make any specific recommendations for management.

Type
Review Article
Copyright
© Scandinavian College of Neuropsychopharmacology 2018 

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References

1. Achim, AM, Maziade, M, Raymond, E, Olivier, D, Mérette, C Roy, M-A (2011) How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophr Bull 37, 811821.Google Scholar
2. Rapp, EK, White-Ajmani, ML, Antonius, D, Goetz, RR, Harkavy-Friedman, JM, Savitz, AJ, Malaspina, D Kahn, JP (2012) Schizophrenia comorbid with panic disorder: evidence for distinct cognitive profiles. Psychiatr Res 197, 206211.Google Scholar
3. Baynes, D, Mulholland, C ,Cooper, SJ, Montgomery, RC, MacFlynn, G, Lynch, G, Kelly, C King, DJ (2000) Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment. Schizophr Res 45, 4756.Google Scholar
4. Buckley, PF, Miller, BJ, Lehrer, DS Castle, DJ (2009) Psychiatric comorbidities and schizophrenia. Schizophr Bull 35, 383402.Google Scholar
5. Poyurovsky, M, Kriss, V, Weisman, G, Faragian, S, Kurs, R, Schneidman, M, Fuchs, C, Weizman, A Weizman, R (2003) Comparison of clinical characteristics and comorbidity in schizophrenia patients with and without obsessive-compulsive disorder: schizophrenic and OC symptoms in schizophrenia. J Clin Psychiatry 64, 13001307.Google Scholar
6. Poyurovsky, M, Hramenkov, S, Isakov, V, Rauchverger, B, Modai, I, Schneidman, M, Fuchs, C Weizman, A (2001) Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia. Psychiatry Res 102, 4957.Google Scholar
7. Poyurovsky, M Koran, LM (2005) Obsessive-compulsive disorder (OCD) with schizotypy vs. schizophrenia with OCD: diagnostic dilemmas and therapeutic implications. J Psychiatr Res 39, 399408.Google Scholar
8. Poyurovsky, M, Faragian, S, Pashinian, A, Heidrach, L, Fuchs, C, Weizman, R Koran, L (2008) Clinical characteristics of schizotypal-related obsessive-compulsive disorder. Psychiatr Res 159, 254258.Google Scholar
9. Nechmad, A, Ratzoni, G, Poyurovsky, M, Meged, S, Avidan, G, Fuchs, C, Bloch, Y Weizman, R (2003) Obsessive-compulsive disorder in adolescent schizophrenia patients. Am J Psychiatry 160, 10021004.Google Scholar
10. Bottas, A, Cooke, RG Richter, MA (2005) Comorbidity and pathophysiology of obsessive-compulsive disorder in schizophrenia: is there evidence for a schizo-obsessive subtype of schizophrenia? J Psychiatry Neurosci 30, 187193.Google Scholar
11. Baer, L, Jenike, MA, Ricciardi, JN 2nd, Holland, AD, Seymour, RJ, Minichiello, WE Buttolph, ML (1990) Standardized assessment of personality disorders in obsessive-compulsive disorder. Arch Gen Psychiatry 47, 826830.Google Scholar
12. Matsunaga, H, Kiriike, N, Matsui, T, Oya, K, Iwasaki, Y, Koshimune, K, Miyata, A Stein, DJ (2002) Obsessive-compulsive disorder with poor insight. Compr Psychiatry 43, 150157.Google Scholar
13. Decker, HS (2004) The psychiatric works of Emil Kraepelin: a many-faceted story of modern medicine. J Hist Neurosci 13, 248276.Google Scholar
14. Steinberg, H, Carius, D, Fontenelle, LF, Steinberg, H, Carius, D Fontenelle, LF (2017) Kraepelin’s views on obsessive neurosis: a comparison with DSM-5 criteria for obsessive-compulsive disorder. Rev Bras Psiquiatr 39, 355364.Google Scholar
15. Bleuler, E (1956) Dementia Praecox or the Group of Schizophrenias. New York, NY: International University Press.Google Scholar
16. Stengel, E (1945) A study on some clinical aspects of the relationship between obsessional neurosis and psychotic reaction types. J Ment Sci 91, 166184.Google Scholar
17. Hoch, P Polatin, P (1949) Pseudoneurotic forms of schizophrenia. Psychiatr Q 23, 248276.Google Scholar
18. Hoch, P, Cattell, J, Strahl, M Pennes, H (1962) The course and outcome of pseudoneurotic schizophrenia. Am J Psychiatry 119, 106115.Google Scholar
19. Niendam, TA, Berzak, J, Cannon, TD Bearden, CE (2009) Obsessive compulsive symptoms in the psychosis prodrome: correlates of clinical and functional outcome. Schizophr Res 108, 170175.Google Scholar
20. Eisen, JL, Beer, DA, Pato, MT, Venditto, TA Rasmussen, SA (1997) Obsessive-compulsive disorder in patients with schizophrenia or schizoaffective disorder. Am J Psychiatry 154, 271273.Google Scholar
21. Karno, M, Golding, JM, Sorenson, SB Burnam, MA (1988) The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry 45, 10941099.Google Scholar
22. Tibbo, P, Kroetsch, M, Chue, P Warneke, L (2000) Obsessive-compulsive disorder in schizophrenia. J Psychiatr Res 34, 139146.Google Scholar
23. Fenton, WS McGlashan, TH (1986) The prognostic significance of obsessive-compulsive symptoms in schizophrenia. Am J Psychiatry 143, 437441.Google Scholar
24. de Haan, L, Schirmbeck, F Zink, M (2015) Obsessive-Compulsive Symptoms in Schizophrenia. Switzerland: Springer.Google Scholar
25. Schirmbeck, F Zink, M (2013) Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors. Fron Pharmacol 4, 114.Google Scholar
26. de Haan, L, Sterk, B Van der Valk, R (2013) Presence of obsessive compulsive symptoms in first-episode schizophrenia or related disorders is associated with subjective well-being and quality of life. Early Interv Psychiatry 7, 285290.Google Scholar
27. de Haan, L, Sterk, B, Wouters, L Linszen, DH (2013) The 5-year course of obsessive-compulsive symptoms and obsessive-compulsive disorder in first-episode schizophrenia and related disorders. Schizophr Bull 39, 151160.Google Scholar
28. Swets, M, Dekker, J, Van Emmerik-van Oortmerssen, K, Smid, GE, Smit, F, de Haan, L Schoevers, RA (2014) The obsessive compulsive spectrum in schizophrenia, a meta-analysis and meta-regression exploring prevalence rates. Schizophr Res 152, 458468.Google Scholar
29. Frías-Ibáñez, A, Palma-Sevillano, C Farriols-Hernando, N (2014) Comorbidity between obsessive-compulsive disorder and schizophrenia: prevalence, explanatory theories, and nosological status. Actas Esp Psiquiatr 42, 2838.Google Scholar
30. Scotti-Muzzi, E Saide, OL (2017) Schizo-obsessive spectrum disorders: an update. CNS Spectr 22, 258272.Google Scholar
31. Fontenelle, LF, Lin, A, Pantelis, C, Wood, SJ, Nelson, B Yung, AR (2011) A longitudinal study of obsessive-compulsive disorder in individuals at ultra-high risk for psychosis. J Psychiatr Res 45, 11401145.Google Scholar
32. Cederlöf, M, Lichtenstein, P, Larsson, H, Boman, M, Rück, C, Landén, M Mataix-Cols, D (2015) Obsessive-compulsive disorder, psychosis, and bipolarity: a longitudinal cohort and multigenerational family study. Schizophr Bull 41, 10761083.Google Scholar
33. Meier, SM, Petersen, L, Pedersen, MG, Arendt, MC, Nielsen, PR, Mattheisen, M, Mors, O Mortensen, PB (2014) Obsessive-compulsive disorder as a risk factor for schizophrenia: a nationwide study. JAMA Psychiatry 71, 12151221.Google Scholar
34. Busatto, GF Kerwin, RW (1997) Perspectives on the role of serotonergic mechanisms in the pharmacology of schizophrenia. J Psychopharmacol (Oxford) 11, 312.Google Scholar
35. Goodman, WK, McDougle, CJ, Price, LH, Riddle, MA, Pauls, DL Leckman, JF (1990) Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive compulsive disorder? J Clin Psychiatry 51(Suppl. 36–43); discussion 5558.Google Scholar
36. Venkatasubramanian, G, Rao, NP Behere, RV (2009) Neuroanatomical, neurochemical, and neurodevelopmental basis of obsessive-compulsive symptoms in schizophrenia. Indian J Psychol Med 31, 310.Google Scholar
37. Kang, D-H, Kim, SH, Kim, CW, Choi, JS, Jang, JH, Jung, MH, Lee, JM, Kim, SI Kwon, JS (2008) Thalamus surface shape deformity in obsessive-compulsive disorder and schizophrenia. Neuroreport 19, 609613.Google Scholar
38. Kwon, JS, Shin, Y-W, Kim, CW, Kim, YI, Youn, T, Han, MH, Chang, KH Kim, JJ (2003) Similarity and disparity of obsessive-compulsive disorder and schizophrenia in MR volumetric abnormalities of the hippocampus-amygdala complex. J Neurol Neurosurg Psychiatry 74, 962964.Google Scholar
39. Fonseka, TM, Richter, MA Müller, DJ (2014) Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature. Curr Psychiatry Rep 16, 510.Google Scholar
40. Lykouras, L, Alevizos, B, Michalopoulou, P Rabavilas, A (2003) Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry 27, 333346.Google Scholar
41. Scheltema Beduin, AA, Swets, M, Machielsen, M, Korver, N Genetic, Risk, Outcome of Psychosis Investigators (2012) Obsessive-compulsive symptoms in patients with schizophrenia: a naturalistic cross-sectional study comparing treatment with clozapine, olanzapine, risperidone, and no antipsychotics in 543 patients. J Clin Psychiatry 73, 13951402.Google Scholar
42. Schirmbeck, F, Rausch, F, Englisch, S, Eifler, S, Esslinger, C, Meyer-Lindenberg, A Zink, M (2013) Differential effects of antipsychotic agents on obsessive-compulsive symptoms in schizophrenia: a longitudinal study. J Psychopharmacol (Oxford) 27, 349357.Google Scholar
43. Schirmbeck, F, Esslinger, C, Rausch, F, Englisch, S, Meyer-Lindenberg, A Zink, M (2011) Antiserotonergic antipsychotics are associated with obsessive-compulsive symptoms in schizophrenia. Psychol Med 41, 23612373.Google Scholar
44. Stewart, SE, Fagerness, JA, Platko, J, Smoller, JW, Scharf, JM, Illmann, C, Jenike, E, Chabane, N, Leboyer, M, Delorme, R, Jenike, MA Pauls, DL (2007) Association of the SLC1A1 glutamate transporter gene and obsessive-compulsive disorder. Am J Med Genet 144B, 10271033.Google Scholar
45. Veenstra-VanderWeele, J, Kim, S-J, Gonen, D, Hanna, GL, Leventhal, BL Cook, EH Jr (2001) Genomic organization of the SLC1A1/EAAC1 gene and mutation screening in early-onset obsessive-compulsive disorder. Mol Psychiatry 6, 160167.Google Scholar
46. Wendland, JR, Moya, PR, Timpano, KR, Anavitarte, AP, Kruse, MR, Wheaton, MG, Ren-Patterson, RF Murphy, DL (2009) A haplotype containing quantitative trait loci for SLC1A1 gene expression and its association with obsessive-compulsive disorder. Arch Gen Psychiatry 66, 408416.Google Scholar
47. Oulis, P, Konstantakopoulos, G, Lykouras, L Michalopoulou, PG (2013) Differential diagnosis of obsessive-compulsive symptoms from delusions in schizophrenia: a phenomenological approach. World J Psychiatry 3, 5056.Google Scholar
48. Tonna, M, Ottoni, R, Paglia, F, Monici, A, Ossola, P, DE Panfilis, C Marchesi, C (2016) Obsessive-compulsive symptoms in schizophrenia and in obsessive-compulsive disorder: differences and similarities. J Psychiatr Pract 22, 111116.Google Scholar
49. Boyette, L, Swets, M, Meijer, C Wouters, L, GROUP Authors (2011) Factor structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) in a large sample of patients with schizophrenia or related disorders and comorbid obsessive-compulsive symptoms. Psychiatry Res 186, 409413.Google Scholar
50. Kim, JH, Ryu, S, Nam, HJ, Lim, M, Baek, JH, Joo, YH, Kwon, JS, Ha, TH Hong, KS (2012) Symptom structure of antipsychotic-induced obsessive compulsive symptoms in schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 39, 7579.Google Scholar
51. Seedat, F, Roos, JL, Pretorius, HW, Karayiorgou, M Nel, B (2007) Prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive compulsive symptoms in Afrikaner schizophrenia and schizoaffective disorder patients. Afr J Psychiatry (Johannesbg) 10, 219224.Google Scholar
52. Roth, RM, Baribeau, J (2000) The relationship between schizotypal and obsessive-compulsive features in university students. Pers Individ Dif 29, 10831093.Google Scholar
53. Eisen, JL Rasmussen, SA (1993) Obsessive compulsive disorder with psychotic features. J Clin Psychiatry 54, 373379.Google Scholar
54. Harris, CL Dinn, WM (2003) Subtyping obsessive-compulsive disorder: neuropsychological correlates. Behav Neurol 14, 7587.Google Scholar
55. Jenike, MA, Baer, L, Minichiello, WE, Schwartz, CE Carey, RJ (1986) Concomitant obsessive-compulsive disorder and schizotypal personality disorder. Am J Psychiatry 143, 530532.Google Scholar
56. Mundo, E, Erzegovesi, S Bellodi, L (1995) Follow-up of obsessive–compulsive 726 patients treated with proserotonergic agents. J Clin Psychopharmacol 15, 288289.Google Scholar
57. McDougle, CJ, Goodman, WK, Price, LH, Delgado, PL, Krystal, JH, Charney, DS Heninger, GR (1990) Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry 147, 652654.Google Scholar
58. Bogetto, F, Bellino, S, Vaschetto, P Ziero, S (2000) Olanzapine augmentation of fluvoxamine-refractory obsessive-compulsive disorder (OCD): a 12-week open trial. Psychiatry Res 96, 9198.Google Scholar
59. Cunill, R, Castells, X Simeon, D (2009) Relationships between obsessive-compulsive symptomatology and severity of psychosis in schizophrenia: a systematic review and meta-analysis. J Clin Psychiatry 70, 7082.Google Scholar
60. Poyurovsky, M, Weizman, A Weizman, R (2004) Obsessive-compulsive disorder in schizophrenia: clinical characteristics and treatment. CNS Drugs 18, 9891010.Google Scholar
61. Cunill, R Castells, X (2011)) Schizo-obsessive disorder. In: Ritsner M, editor Handbook of schizophrenia spectrum disorders, vol. II. London and Dordrecht: Springer, pp. 403–448.Google Scholar
62. Ritsner, MS (2011)) Handbook of schizophrenia spectrum disorders: phenotypic and endophenotypic presentations. London: Springer Science & Business Media.Google Scholar
63. Kozak, MJ Foa, EB (1994) Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder. Behav Res Ther 32, 343353.Google Scholar
64. Berman, I, Merson, A, Viegner, B, Losonczy, MF, Pappas, D Green, AI (1998) Obsessions and compulsions as a distinct cluster of symptoms in schizophrenia: a neuropsychological study. J Nerv Ment Dis. 186, 150156.Google Scholar
65. Ongür, D Goff, DC (2005) Obsessive-compulsive symptoms in schizophrenia: associated clinical features, cognitive function and medication status. Schizophr Res 75, 349362.Google Scholar
66. Tumkaya, S, Karadag, F, Oguzhanoglu, NK, Tekkanat, C, Varma, G, Ozdel, O Ateşçi, F (2009) Schizophrenia with obsessive-compulsive disorder and obsessive-compulsive disorder with poor insight: a neuropsychological comparison. Psychiatry Res 165, 3846.Google Scholar
67. Whitney, KA, Fastenau, PS, Evans, JD Lysaker, PH (2004) Comparative neuropsychological function in obsessive-compulsive disorder and schizophrenia with and without obsessive-compulsive symptoms. Schizophr Res 69, 7583.Google Scholar
68. Frías, Á, Palma, C, Farriols, N, Becerra, C, Álvarez, A Cañete, J (2014) Neuropsychological profile and treatment-related features among patients with comorbidity between schizophrenia spectrum disorder and obsessive–compulsive disorder: is there evidence for a ‘schizo-obsessive’ subtype? Psychiatry Res 220, 846854.Google Scholar
69. Schirmbeck, F, Rausch, F, Englisch, S, Eifler, S, Esslinger, C, Meyer-Lindenberg, A Zink, M (2013) Stable cognitive deficits in schizophrenia patients with comorbid obsessive-compulsive symptoms: a 12-month longitudinal study. Schizophr Bull 39, 12611271.Google Scholar
70. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). Arlington,VA: American Psychiatric Publishing.Google Scholar
71. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.Google Scholar
72. Luciano, M (2015) The ICD-11 beta draft is available online. World Psychiatry 14, 375376.Google Scholar
73. Reed, GM, First, MB, Elena Medina‐Mora, M, Gureje, O, Pike, KM Saxena, S (2016) Draft diagnostic guidelines for ICD‐11 mental and behavioural disorders available for review and comment. World Psychiatry 15, 112113.Google Scholar
74. World Health Organization . ICD-11 Beta Draft - mortality and morbidity statistics. Available at https://icd.who.int/dev11/l-m/en. Accessed February 25, 2018.Google Scholar
75. Zink, M (2014) Comorbid obsessive-compulsive symptoms in schizophrenia: insight into pathomechanisms facilitates treatment. Advances in Medicine 2014, 118.Google Scholar
76. Huppert, JD, Walther, MR, Hajcak, G, Yadin, E, Foa, EB, Simpson, HB Liebowitz, MR (2007) The OCI-R: validation of the subscales in a clinical sample. J Anxiety Disord 21, 394406.Google Scholar
77. Opakunle, T, Aloba, O, Akinsulore, A, Opakunle, O Fatoye, F (2018) Obsessive-compulsive inventory-revised: factor structure, reliability, validity, and suicide risk screening characteristics among Nigerian patients with schizophrenia. J Neurosci Rural Pract 9, 219225.Google Scholar
78. Fernandez-Egea, E, Worbe, Y, Bernardo, M Robbins, TW (2018) Distinct risk factors for obsessive and compulsive symptoms in chronic schizophrenia. Psychol Med 18.Google Scholar
79. Veale, D, Miles, S, Smallcombe, N, Ghezai, H, Goldacre, B Hodsoll, J (2014) Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis. BMC Psychiatry 14, 317.Google Scholar
80. Bloch, MH, Landeros-Weisenberger, A, Kelmendi, B, Coric, V, Bracken, MB Leckman, JF (2006) A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry 11, 622632.Google Scholar
81. Englisch, S, Esslinger, C, Inta, D, Weinbrenner, A, Peus, V, Gutschalk, A, Schirmbeck, F Zink, M (2009) Clozapine-induced obsessive-compulsive syndromes improve in combination with aripiprazole. Clin Neuropharmacol 32, 227229.Google Scholar
82. Kim, S-W, Shin, I-S, Kim, JM, Youn, T, Yang, SJ, Hwang, MY Yoon, JS (2009) The 5-HT2 receptor profiles of antipsychotics in the pathogenesis of obsessive-compulsive symptoms in schizophrenia. Clin Neuropharmacol 32, 224226.Google Scholar
83. Schönfelder, S, Schirmbeck, F, Waltereit, R, Englisch, S Zink, M (2011) Aripiprazole improves olanzapine-associated obsessive compulsive symptoms in schizophrenia. Clin Neuropharmacol 34, 256257.Google Scholar
84. Poyurovsky, M (2013) Antipsychotic-drug-induced obsessive–compulsive symptoms. In: Poyurvosky M editors Schizo-obsessive disorder. Cambridge: Cambridge University Press, pp. 213–222.Google Scholar
85. Berman, I, Sapers, BL, Chang, HH, Losonczy, MF, Schmildler, J Green, AI (1995) Treatment of obsessive-compulsive symptoms in schizophrenic patients with clomipramine. J Clin Psychopharmacol 15, 206210.Google Scholar
86. Zohar, J, Kaplan, Z Benjamin, J (1993) Clomipramine treatment of obsessive compulsive symptomatology in schizophrenic patients. J Clin Psychiatry 54, 385388.Google Scholar
87. Kantrowitz, JT Tampi, RR (2008) Risk of psychosis exacerbation by tricyclic antidepressants in unipolar Major Depressive Disorder with psychotic features. J Affect Disord 106, 279284.Google Scholar
88. Poyurovsky, M, Isakov, V, Hromnikov, S, Modai, I, Rauchberger, B, Schneidman, M Weizman, A (1999) Fluvoxamine treatment of obsessive-compulsive symptoms in schizophrenic patients: an add-on open study. Int Clin Psychopharmacol 14, 95100.Google Scholar
89. Reznik, I Sirota, P (2000) Obsessive and compulsive symptoms in schizophrenia: a randomized controlled trial with fluvoxamine and neuroleptics. J Clin Psychopharmacol 20, 410416.Google Scholar
90. Agarwal, V Agarwal, KM (2000) Treatment of obsessive compulsive symptoms in schizophrenia with fluoxetine. Indian J Psychiatry 42, 291294.Google Scholar
91. Geller, DA, Biederman, J, Stewart, SE, Mullin, B, Farrell, C, Wagner, KD, Emslie, G Carpenter, D (2003) Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J Child Adolesc Psychopharmacol 13(Suppl. 1):S19S29.Google Scholar
92. Poyurovsky, M, Kurs, R Weizman, A (2003) Olanzapine-sertraline combination in schizophrenia with obsessive-compulsive disorder. J Clin Psychiatry 64, 611.Google Scholar
93. Rahman, MS, Grace, JJ, Pato, MT Priest, B (1998) Sertraline in the treatment of clozapine-induced obsessive-compulsive behavior. Am J Psychiatry 155, 16291630.Google Scholar
94. Hemeryck, A Belpaire, FM (2002) Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update. Curr Drug Metab 3, 1337.Google Scholar
95. Schirmbeck, F Zink, M (2012) Clozapine-induced obsessive-compulsive symptoms in schizophrenia: a critical review. Curr Neuropharmacol 10, 8895.Google Scholar
96. Poyurovsky, M, Glick, I Koran, LM (2010) Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms. J Psychopharmacol (Oxford) 24, 861866.Google Scholar
97. Schwarz, C, Volz, A, Li, C Leucht, S (2008) Valproate for schizophrenia. Cochrane Database Syst Rev 11, CD004028.Google Scholar
98. Tundo, A Necci, R (2016) Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: systematic review of evidence. World J Psychiatry 6, 449455.Google Scholar
99. Tundo, A, Salvati, L, Spigno, DD, Di Spigno, D, Cieri, L, Parena, A, Necci, R Sciortino, S (2012) Cognitive-behavioral therapy for obsessive-compulsive disorder as a comorbidity with schizophrenia or schizoaffective disorder. Psychother Psychosom 81, 5860.Google Scholar
100. National Institute for Health and Clinical Excellence (2014) Psychosis and schizophrenia in adults: prevention and management. Guidance and guidelines. London: The British Psychological Society and The Royal College of Psychiatrists. Available at https://www.nice.org.uk/guidance/cg178. Accessed July 6, 2018.Google Scholar
101. Fontenelle, LF, Coutinho, ESF, Lins-Martins, NM, Fitzgerald, PB, Fujiwara, H Yücel, M (2015) Electroconvulsive therapy for obsessive-compulsive disorder: a systematic review. J Clin Psychiatry 76, 949957.Google Scholar
102. Mendes-Filho, VA, Belmonte-de-Abreu, P, Pedrini, M, Cachoeira, CT Lobato, MR (2013) rTMS as an add-on treatment for resistant obsessive-compulsive symptoms in patients with schizophrenia: report of three cases. Rev Bras Psiquiatr 35, 211.Google Scholar
103. Mendes-Filho, VA, De Jesus, DR, Belmonte-de-Abreu, P, Cachoeira, CT Rodrigues Lobato, MI (2016) Effects of repetitive transcranial magnetic stimulation over supplementary motor area in patients with schizophrenia with obsessive-compulsive-symptoms: a pilot study. Psychiatry Res 242, 3438.Google Scholar
104. Lehman, AF, Lieberman, JA, Dixon, LB, McGlashan, TH, Miller, AL, Perkins, DO Kreyenbuhl, J (2004) Practice guideline for the treatment of patients with schizophrenia,second edition. American Psychiatric Association; Steering Committee on Practice Guidelines. Am J Psychiatry 161, 156.Google Scholar
105. Poyurovsky, M (2013) Treatment of schizophrenia with obsessive–compulsive symptoms. In: Poyurvosky M editors Schizo-obsessive disorder. Cambridge: Cambridge University Press, pp. 194–212.Google Scholar
106. Poyurovsky, M, Zohar, J, Glick, I, Koran, LM, Weizman, R, Tandon, R Weizman, A (2012) Obsessive-compulsive symptoms in schizophrenia: implications for future psychiatric classifications. Compr Psychiatry 53, 480483.Google Scholar