Patients with
schizophrenia often experience comorbid obsessive-compulsive syndromes (OCSs). Within these patients, a significant subgroup developed secondary OCS during treatment with antiserotonergic, atypical
antipsychotic agents such as
clozapine. Although cognitive behavioral therapy and antiobsessive
antidepressants brought up inconsistent results, in some cases,
dose reductions of
clozapine in combination approaches were able to alleviate OCS. One suggestive agent for antiobsessive add-on treatment is
aripiprazole, a partial agonist at
dopamine and
serotonin receptors.Here, we summarize the courses of 7 patients (6 men; mean age, 37 years; mean duration of psychotic illness, 17 years). They had been treated with
clozapine for 9 years. The distressing and treatment-resistant comorbidity with OCS emerged approximately 4 years after the start of
clozapine therapy. During combined treatment with mean doses of 22.9 mg of
aripiprazole for 9.7 weeks, we assessed a small yet statistically not significant improvement of the
psychotic disorder, whereas a marked reduction of obsessions and significant improvements of compulsions could be observed. The mean total Yale Brown Obsessive Compulsive Rating Scale decreased from 18.7 to 12.4 (P = 0.003).These data support the findings of 2 previous case reports and point toward an antiobsessive potency of
aripiprazole. The relevant disabling comorbidities of
psychosis and OCS need further investigation with multimodal neurobiological approaches. The proposed strategy should be further evaluated in prospective controlled trials with severity of comorbid OCS as a primary end point.