0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters to the Editor   |    
Schizophrenia and Obsessive-Compulsive Disorder
Kavi Devulapalli, B.A, M.P.H.; Henry A. Nasrallah, M.D.
Am J Psychiatry 2010;167:1407-1408. doi:10.1176/appi.ajp.2010.10081111
View Author and Article Information
Cleveland, Ohio
Cincinnati, Ohio

accepted for publication in August 2010.

Dr. Nasrallah has received research grant support from Forest, Janssen, Otsuka, and Shire; and he has served on the advisory board or speaker's bureau of AstraZeneca, Janssen, Merck, Novartis, Pfizer, and Sepracor. Dr. Devulapalli reports no financial relationships with commercial interests.

Accepted August , 2010.

Copyright © American Psychiatric Association

To the Editor: In the July 2010 issue of the Journal, Carolyn I. Rodriguez, M.D., Ph.D., et al. (1) presented an interesting case illustrating the complexities of co-occurring psychotic and obsessive-compulsive disorders (OCD). The authors should be commended for their careful review of the differential diagnosis and treatments for a patient presenting with these intertwined symptoms.

In the case study, the patient was found to have manifested obsessive compulsive symptoms prior to his first psychotic episode. Such a presentation is consistent with the results of a meta-analysis we conducted regarding the temporal relationship of OCD and schizophrenia in patients suffering from both disorders (2). Our analysis showed that in patients diagnosed with both disorders, OCD tends to precede schizophrenia by 1 year. While our study did not find this result to be statistically significant, it did nearly reach significance (p=0.066), suggesting the potential for statistical significance in studies with a larger sample size. Clearly, Dr. Rodriguez et al.'s suggestions for longitudinal studies of young people at risk for psychosis or OCD would provide for much needed insight into the epidemiology and clinical phenomenology of cooccurring obsessive compulsive and psychotic symptoms.

In their discussion of the potential adverse drug-drug interactions between clozapine and fluvoxamine, the authors appropriately mentioned cytochrome 3A4. We would like to also mention that cytochrome 1A2 is even more significantly involved in the metabolism of clozapine (3). As a strong inhibitor of cyto-chrome 1A2, combining fluvoxamine with clozapine in patients suffering from both OCD and treatment-resistant schizophrenia may produce serious adverse effects. Further, nicotine in tobacco is an inducer of cytochrome 1A2 and may lead to attenuation of the efficacy of clozapine unless the dose is increased.

Rodriguez  CI;  Corcoran  C;  Simpson  HS:  Diagnosis and treatment of a patient with psychotic and obsessive-compulsive symptoms.  Am J Psychiatry 2010; 167:755—761
[CrossRef]
 
Devulapalli  KK;  Welge  JA;  Nasrallah  HA:  Temporal sequence of clinical manifestation in schizophrenia with co-morbid OCD: review and meta-analysis.  Psychiatry Res 2008; 161:105—108
[CrossRef] | [PubMed]
 
Chetty  M;  Murray  M:  CYP-mediated clozapine interactions: How predictable are they? Curr Drug Metab 2007; 8:307—313
[CrossRef] | [PubMed]
 
References Container
+

References

Rodriguez  CI;  Corcoran  C;  Simpson  HS:  Diagnosis and treatment of a patient with psychotic and obsessive-compulsive symptoms.  Am J Psychiatry 2010; 167:755—761
[CrossRef]
 
Devulapalli  KK;  Welge  JA;  Nasrallah  HA:  Temporal sequence of clinical manifestation in schizophrenia with co-morbid OCD: review and meta-analysis.  Psychiatry Res 2008; 161:105—108
[CrossRef] | [PubMed]
 
Chetty  M;  Murray  M:  CYP-mediated clozapine interactions: How predictable are they? Curr Drug Metab 2007; 8:307—313
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Textbook of Psychotherapeutic Treatments > Chapter 6.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 8.  >
Textbook of Psychotherapeutic Treatments > Chapter 8.  >
DSM-5™ Clinical Cases > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 12.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles
[Bipolar depression in the clinic of schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2014;114(7):9-16.