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Risperidone-Induced Obsessive-Compulsive Symptoms: A Series of Six Cases

2002; Lippincott Williams & Wilkins; Volume: 22; Issue: 5 Linguagem: Inglês

10.1097/00004714-200210000-00004

1533-712X

B. Alevizos, Lefteris Lykouras, Iannis M. Zervas, George N. Christodoulou,

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Risperidone is a novel and atypical agent with a dual antagonistic effect on 5-HT2 and D2 receptors. Open-label reports and one controlled study suggest that risperidone addition is effective in patients with obsessive-compulsive disorder refractory to treatment with serotonin reuptake inhibitors. However, risperidone has also been implicated in the production or exacerbation of obsessive-compulsive symptoms. We report six cases (schizophrenia, five cases; psychotic depression, one case) in which risperidone was effective in the treatment of the psychotic symptoms but produced de novo obsessive-compulsive symptoms (four cases) or caused exacerbation of previous obsessive-compulsive symptoms (two cases). In all but one case, obsessive-compulsive symptoms emerged shortly after initiation of risperidone treatment with a dose above 3 mg/day. The mechanisms and risk factors for risperidone and other atypical antipsychotics to induce or exacerbate obsessive-compulsive symptoms are as yet not clear. Risperidone-induced obsessive-compulsive symptoms appear to be dose-dependent and are probably produced by serotoninergic-dopaminergic imbalance. Close monitoring of the patients receiving risperidone, especially those vulnerable to the development of obsessive-compulsive symptoms, may be of value. Gradual escalation and low final dose may be helpful.