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Obsessive-compulsive disorder (OCD) is common in clozapine-treated patients although the actual prevalence, phenomenology and risk factors remain unclear. The aim of the present study was to address the three aforementioned questions.
The electronic records of a large cohort of clozapine-medicated schizophrenia patients routinely screened for OCD were used. The Obsessive Compulsive Inventory Revised version (OCI-R) was available from 118 cases and a 21 points cut-off threshold for OCD was defined.
OCD prevalence was 47%, higher in patients on poly-pharmacy than on monotherapy (64% vs 31%; p = 0.001). Two OCI-R factors had significantly higher scores and distinct risk factors: checking behaviour (mean = 5.1; SD = 3.6) correlated with length of clozapine treatment (r = 0.21; p = 0.026), and obsessing factor (mean = 4.8; SD = 3.6) correlated with psychosis severity (r = 0.59; p = 0.001). These factors along with total OCI-R, did not correlate with either clozapine dose or plasma levels, after correcting for psychosis severity.
Screening for OCD in clozapine patients, and probably in those treated with structurally similar drugs with potent antiserotoninergic properties, should be widely adopted by clinicians. Further research is needed to understand the pathophysiology underlying repetitive behavior onset in clozapine-treated patients.
This chapter reviews magnetic resonance (MR) techniques from conventional structural MRI to advanced MRI (volumetry, magnetization transfer (MT), neuromelanin imaging, diffusion imaging, and rs-fMRI). It outlines the ways in which these techniques may be used to detect changes in the brain of Parkinson's disease (PD) patients and their relationships with Parkinsonian symptoms. Functional connectivity (FC) methods that take advantage of intrinsic signal fluctuations have demonstrated that the interactions of brain networks are abnormal in PD at the resting state. MRI has proven useful in the differential diagnosis of the various atypical Parkinsonian disorders such as progressive supranuclear palsy (PSP) and the Parkinson variant of multiple system atrophy (MSA-P). In PD, changes in the basal ganglia and brainstem are subtle and restricted to nuclei such as the substantia nigra (SN) and locus coeruleus (LC). PSP patients present extensive changes in the brainstem, basal ganglia, and cortical regions.
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