Clozapine Induced Obsessions Treated with Sertraline in an Adolescent with Schizophrenia

Abstract

Obsessive-compulsive disorder has been reported up to 26 percent in subjects with schizophrenia. Meanwhile treatment with antipsychotic medications, particularly with clozapine, has been reported to be associated with the emergence or exacerbation of obsessive-compulsive symptoms or disorder. These preexisting or treatment-induced obsessive-compulsive symptoms, particularly obsessions, may go unrecognized and result in further functional impairment and poor treatment compliance. Management of this adverse event could be troublesome in the clinical setting. We report an adolescent boy with a diagnosis of schizophrenia who developed severe religious obsessions during clozapine treatment in a dose dependent fashion. We discuss the possible pathophysiological mechanisms of clozapine-induced obsessive-compulsive symptoms, clinical implications, and successful management of this adverse event by adding sertraline to the treatment regimen.