Antipsychotics and obsessive-compulsive disorder/obsessive-compulsive symptoms: A pharmacovigilance study of the FDA adverse event reporting system.

Abstract

OBJECTIVE:

Antipsychotics have conflicting data with respect to obsessive-compulsive disorder/symptoms (OCD/OCS), with some reporting causality and some reporting treatment benefits. This pharmacovigilance study aimed to investigate reporting of OCD/OCS in association with the use of antipsychotics in comparison to one another, as well as treatment failure using data derived from the FDA Adverse Event Reporting System (FAERS).

METHODS:

Data from January 1st, 2010 to December 31st, 2020 on suspected adverse drug reactions (ADRs) including OCD/OCS was obtained. The information component (IC) was used to determine a disproportionality signal, and reporting odds ratio (ROR) calculations were performed via intra-class analyses to discern differences between the evaluated antipsychotics.

RESULTS:

A total of 1454 OCD/OCS cases were utilized in IC and ROR calculations and 385,972 suspected ADRs were used as non-cases. A significant disproportionality signal was seen with all second generation antipsychotics. Relative to other antipsychotics, only aripiprazole had a significant ROR of 23.87 (95% CI: 21.01-27.13; p < 0.0001). The ROR for antipsychotic treatment failure in those with OCD/OCS was highest with aripiprazole, and lowest with risperidone and quetiapine. Sensitivity analyses were largely in favor of the primary findings. Our analysis appears to implicate the 5-HT1A receptor or an imbalance between this receptor and the D2 -receptor in antipsychotic treatment-emergent OCD/OCS.

CONCLUSIONS:

In contrast to prior reports noting clozapine as the antipsychotic most commonly associated with de novo or exacerbated OCD/OCS, this pharmacovigilance study found aripiprazole was most frequently reported for this adverse effect. While these findings from FAERS offer a unique perspective on OCD/OCS with different antipsychotic agents, due to the inherent limitations of pharmacovigilance studies they should ideally be validated through alternative prospective research studies involving direct comparisons of antipsychotic agents.

• Authors: Bradley G Burk, Tilyn DiGiacomo, Shea Polancich, Brandon S Pruett, Soumya Sivaraman, Badari Birur
• Journal: Acta psychiatrica Scandinavica (Acta Psychiatr Scand) Vol. 148 Issue 1 Pg. 32-46 (07 2023) ISSN: 1600-0447 [Electronic] United States
• PMID: 37194481 (Publication Type: Journal Article)
• Copyright: © 2023 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

Chemical References

• Antipsychotic Agents
• Aripiprazole

Topics

• Humans
• Antipsychotic Agents (adverse effects)
• Aripiprazole (adverse effects)
• Pharmacovigilance
• Prospective Studies
• Obsessive-Compulsive Disorder (drug therapy, epidemiology)
• Drug-Related Side Effects and Adverse Reactions (epidemiology)