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Fortschr Neurol Psychiatr 2016; 84(11): 675-681
DOI: 10.1055/s-0042-116227
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Zwangssymptome bei chronisch erkrankten Patienten mit einer Schizophrenie unter Clozapintherapie

Obsessive-Compulsive Symptoms in a Sample of Patients with Chronic Schizophrenia Under Clozapine Treatment
S. Schreiter
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
A. Hasan
2   Klinik für Psychiatrie und Psychotherapie, LMU München
,
T. Majic
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
A. Wullschleger
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
M. Schouler-Ocak
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
F. Bermpohl
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
,
S. Gutwinski
1   Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
15 November 2016 (online)

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Zusammenfassung

Hintergrund: Patienten mit schizophrenen Erkrankungen zeigen eine erhöhte Prävalenz von Zwangssymptomen. Die antipsychotische Medikation, insbesondere Dauer und Art der Therapie, wird dabei als mögliche Ursache diskutiert.

Methode: Untersuchung der Ausprägung von Zwangssymptomen (Obsessive-Compulsive Inventory – Revised) und der Häufigkeit von Zwangsstörungen (F41.X) nach ICD-10 bei 70 Patienten mit einer schizophrenen Erkrankung (F20.X) in einem naturalistischen Querschnittsdesign. Davon befanden sich n = 26 in Behandlung mit Clozapin und n = 44 in Behandlung mit anderen Antipsychotika der zweiten Generation (SGA, Second Generation Antipsychotics). Nach Gruppen-Matching bestanden zwischen beiden Gruppen keine signifikanten Unterschiede bezüglich Alter, Geschlecht, Erkrankungs- und Behandlungsdauer mit der aktuellen antipsychotischen Substanz und Dosis (Äquivalenz).

Ergebnisse: Mit Clozapin behandelte Patienten zeigten eine signifikant höhere Frequenz von Zwangsstörungen (χ2 = 7,304, p = 0,007) sowie einen höheren Ausprägungsgrad von Zwangssymptomen (t = 2,216, p = 0,037) im Vergleich zu Patienten mit anderen SGA. Die Behandlungsdauer mit der aktuellen Substanz korrelierte signifikant (p = 0,033, r = 0,323) mit der Schwere der Zwangssymptomatik, kontrolliert für die Erkrankungsdauer für die gesamte Stichprobe. Eine signifikante Korrelation zwischen Schwere der Zwangssymptomatik und Erkrankungsdauer, kontrolliert für die Behandlungsdauer, zeigte sich hingegen nicht.

Diskussion: Unsere Ergebnisse weisen auf einen Zusammenhang zwischen der Entwicklung von Zwangssymptomen und -störungen und antipsychotischer Medikation, insbesondere mit Clozapin, hin. Dabei korreliert die Behandlungsdauer mit dem Ausprägungsgrad der Zwangssymptomatik, auch unabhängig von der Erkrankungsdauer.

Abstract

Background: There is a high prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Antipsychotic treatment, especially duration and type of substance, is suspected to increase or even cause OCS.

Methods: We examined in a naturalistic cross-sectional study the severity of OCS (Obsessive-Compulsive Inventory – Revised) and the incidence of obsessive-compulsive disorder (OCD) according to ICD-10 criteria in 70 patients with schizophrenia. 26 patients were treated with clozapine and 44 patients were treated with another second-generation antipsychotic (SGA). After group matching, the two groups did not differ significantly in age, gender, duration of illness, treatment duration with the current antipsychotic substance and chlorpromazine-equivalent dosage.

Results: Patients treated with Clozapine showed a significantly higher rate of OCD (χ2 = 7.304, p = 0.007) and a significantly higher severity of OCS (t = 2.216, p = 0.037) compared to patients treated with another SGA. For the whole sample, duration of treatment with the current antipsychotic medication correlated significantly (p = 0.033, r = 0.323) with the severity of OCS, controlled for duration of illness. However, there was no significant correlation between severity of OCS and duration of illness, controlled for duration of treatment with the current antipsychotic substance.

Discussion: Our data suggest an interrelation between the development of OCS or OCD and antipsychotic treatment, especially clozapine. Thereby, duration of treatment is correlated with the severity of OCS, irrespective of the duration of illness.

Schlüsselwörter

Schizophrenie - Zwangsstörung - Clozapin - Antipsychotika

Key words

schizophrenia - obsessive-compulsive disorder - clozapine - antipsychotics
 

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