Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms
One underrecognized adverse event of clozapine is the emergence or worsening of obsessive-compulsive symptoms (OCS). OCS, particularly violent thoughts, can be inaccurately described as psychosis and result in a misdiagnosis. We report a case of a 42-year-old man, initially diagnosed with schizoaffe...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Case Reports in Psychiatry |
| Online Access: | http://dx.doi.org/10.1155/2016/2180748 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832550265213943808 |
|---|---|
| author | Jonathan G. Leung Brian A. Palmer |
| author_facet | Jonathan G. Leung Brian A. Palmer |
| author_sort | Jonathan G. Leung |
| collection | DOAJ |
| description | One underrecognized adverse event of clozapine is the emergence or worsening of obsessive-compulsive symptoms (OCS). OCS, particularly violent thoughts, can be inaccurately described as psychosis and result in a misdiagnosis. We report a case of a 42-year-old man, initially diagnosed with schizoaffective, who was placed on clozapine for the management of “violent delusions.” However, clozapine led to a worsening of these violent thoughts resulting in suicidal ideation and hospitalization. After exploration of the intrusive thoughts and noting these to be egodystonic, clearly disturbing, and time consuming, an alternative diagnosis of obsessive-compulsive disorder (OCD) was made. Clozapine was inevitably discontinued resulting in a significant reduction of the intrusive thoughts without emergence of psychosis or adverse events. While an overlapping phenomenology between OCD and psychotic disorders has been described, clozapine and other antiserotonergic antipsychotics have been implicated with the emergence or worsening of OCS. Unique to our case is that the patient’s obsessions had been treated as psychosis leading to the inadequate treatment of his primary illness, OCD. This case highlights the potential for OCD to masquerade as a psychotic disorder and reminds clinicians that clozapine may worsen OCS. |
| format | Article |
| id | doaj-art-2f4e8f32cf4c43c9a023ee78e6ca00f1 |
| institution | Kabale University |
| issn | 2090-682X 2090-6838 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Psychiatry |
| spelling | doaj-art-2f4e8f32cf4c43c9a023ee78e6ca00f12025-02-03T06:07:06ZengWileyCase Reports in Psychiatry2090-682X2090-68382016-01-01201610.1155/2016/21807482180748Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive SymptomsJonathan G. Leung0Brian A. Palmer1Department of Hospital Pharmacy Services, Mayo Clinic, 200 First Street, Rochester, MN 55905, USADepartment of Psychiatry and Psychology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USAOne underrecognized adverse event of clozapine is the emergence or worsening of obsessive-compulsive symptoms (OCS). OCS, particularly violent thoughts, can be inaccurately described as psychosis and result in a misdiagnosis. We report a case of a 42-year-old man, initially diagnosed with schizoaffective, who was placed on clozapine for the management of “violent delusions.” However, clozapine led to a worsening of these violent thoughts resulting in suicidal ideation and hospitalization. After exploration of the intrusive thoughts and noting these to be egodystonic, clearly disturbing, and time consuming, an alternative diagnosis of obsessive-compulsive disorder (OCD) was made. Clozapine was inevitably discontinued resulting in a significant reduction of the intrusive thoughts without emergence of psychosis or adverse events. While an overlapping phenomenology between OCD and psychotic disorders has been described, clozapine and other antiserotonergic antipsychotics have been implicated with the emergence or worsening of OCS. Unique to our case is that the patient’s obsessions had been treated as psychosis leading to the inadequate treatment of his primary illness, OCD. This case highlights the potential for OCD to masquerade as a psychotic disorder and reminds clinicians that clozapine may worsen OCS.http://dx.doi.org/10.1155/2016/2180748 |
| spellingShingle | Jonathan G. Leung Brian A. Palmer Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms Case Reports in Psychiatry |
| title | Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms |
| title_full | Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms |
| title_fullStr | Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms |
| title_full_unstemmed | Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms |
| title_short | Psychosis or Obsessions? Clozapine Associated with Worsening Obsessive-Compulsive Symptoms |
| title_sort | psychosis or obsessions clozapine associated with worsening obsessive compulsive symptoms |
| url | http://dx.doi.org/10.1155/2016/2180748 |
| work_keys_str_mv | AT jonathangleung psychosisorobsessionsclozapineassociatedwithworseningobsessivecompulsivesymptoms AT brianapalmer psychosisorobsessionsclozapineassociatedwithworseningobsessivecompulsivesymptoms |