Relationship of obsessive compulsive symptoms/disorder with clozapine: A retrospective study from a multispeciality tertiary care centre

• Incidence of OCS/OCD after starting of clozapine is 5.9%.
• In majority (69.2%) of cases, clozapine associated OCS/OCD starts within 12 months of starting of clozapine.
• Pathological doubts are most common obsessions followed by those with sexual content.

ObjectiveTo study the prevalence, phenomenology and course of OCS/OCD in patients receiving clozapine.MethodologyCase records of 220 patients who received clozapine for at least 3 months were reviewed.ResultsOne fifth (N = 42; 19.1%) of patients had OCS/OCD, of which majority (13.2%) had onset of OCS/OCD prior to starting of clozapine and remaining 5.9% developed OCS/OCD after starting of clozapine. About one fourth of the patients with pre-existing OCS/OCD had worsening with clozapine while the remaining maintained at the same level (55.17%) or improved (20.7%). Majority of the patients who developed de novo OCS/OCD on clozapine were females and OCS/OCD emerged within 12 months (69.2%) of starting of clozapine. In those who developed OCS/OCD with clozapine, among obsessions, pathological doubts were most common, followed by obsessions with sexual content; among compulsions repetitive checking was the most common. SSRIs were required for management in half the patients, while the remaining improved spontaneously or with reduction in clozapine dose.ConclusionClozapine can lead to aggravation or de novo presentation of OCS/OCD but these can be managed with reduction in dose or addition of SSRIs.