Psychopharmacology and Psychiatry Updates Clozapine and Compulsions: New Research On An Old Side Effect
Jul 5, 2025
Oliver Freudenreich, a psychiatrist from Boston, dives into the complex relationship between clozapine and obsessive-compulsive symptoms in schizophrenia. He discusses recent research highlighting whether clozapine triggers OCD or if there are deeper psychological mechanisms involved. The conversation covers the prevalence of OCD-like symptoms in clozapine users, the distinction between psychosis and compulsive behaviors, and tailored treatment strategies for improving patient outcomes. With engaging case studies, the episode unpacks the challenges of managing these intertwined symptoms.
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Maria's Case: Clozapine and OCD
- Maria, a 28-year-old with treatment-resistant schizophrenia, improved on clozapine but developed obsessive-compulsive behaviors after six months.
- Her story raises the question if clozapine causes OCD or reveals a deeper behavioral transformation.
Clozapine and OCD Link Complicated
- Up to 50% of patients on clozapine develop OCD-like symptoms, but confounding by indication complicates causation claims.
- Severe psychosis patients both get clozapine and have higher baseline OCD traits, muddying the link.
Two-Phase Model of Checking Habits
- Checking behaviors start as rational protections against paranoia but can evolve into compulsive habits after psychosis fades.
- This two-phase model explains why OCD-like symptoms persist despite clozapine treatment success.