TITLE:
Broader Role for Antipsychotics in the Treatment of Obsessive Compulsive Disorder and Schizophrenia—A Malaysian Case Series
AUTHORS:
Benedict Francis, Stephen Thevananthan Jambunathan, Subash Kumar Pillai
KEYWORDS:
Antipsychotics, Obsessive Compulsive Disorder, Schizophrenia, Monotherapy
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.4,
October
7,
2014
ABSTRACT: Obsessive compulsive
disorder (OCD) and schizophrenia have been considered to be variants of the
same disorder. At the advent of psychiatry, there was a distinction between
neurotic, mood disorders and psychotic disorders. As perceptions and thoughts
evolve in this dynamic field, there has been a paradigm shift in the way these
disorders are being perceived. Of particular interest is that concerning OCD
and schizophrenia. In a much anticipated and very welcomed move, DSM V has now
included delusional beliefs as a specifier of OCD. However the much spoken
about schizo- obsessive syndrome is yet to be explored and addressed. Recurrent
and intrusive thoughts, impulses and images are key experiences seen in OCD.
How we differentiate these vivid images from visual hallucination is a question
yet to be answered. The following case series is an example of how difficult
the boundaries between severe OCD and schizophrenia can be, and the promising
usage of atypical antipsychotic in controlling obsessive compulsive symptoms.
Whether untreated OCD is a significant prodromal symptom of schizophrenia, a
subtype of schizophrenia or an initial indicator of various syndromes, remains
to be seen, depending on environmental effects on the neuroplasticity of the
mind and brain. The cases discussed will highlight the role of antipsychotics
in patients diagnosed as having OCD, and gives strength to the idea that
perhaps antipsychotics should be used more liberally in the treatment of OCD in
schizophrenia. Here, we present a case series to show the use of atypical
antipsychotics as monotherapy or augmenter in quelling obsessive-compulsive
symptoms in patients who fulfilled the DSM V criteria for both schizophrenia
and OCD. The efficacy of antipsychotics in reducing OCD symptoms in psychotic
patients, as shown in this case series, contributes to the body of evidence
that OCD and schizophrenia are really spectrum disorders with a common
denominator. It is hoped that this exciting finding will lead to a paradigm
shift in the usage of antipsychotics in OCD and eventually change how this
disease is viewed and treated.