Evidence map›Paper›PMID 40098472›Full record

ArticlePsychological medicine2025

Clozapine-induced obsessive-compulsive symptoms in schizophrenia: Clinical and cognitive determinants of dysfunctional checking.

Marjan Biria, Paula Banca, Isaac Jarratt Barnham, Aleya A Marzuki, Nuria Segarra, Engin Keser, Akeem Sule, Marija Farrugia, Qiang Luo, Naomi Fineberg and 2 more

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Article in Psychological medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Marjan BiriaDepartment of Psychology, University of Cambridge, CambridgeCB2 3EB, UK.ORCID 0000-0003-2671-0150
Paula BancaDepartment of Psychology, University of Cambridge, CambridgeCB2 3EB, UK.
Isaac Jarratt BarnhamCambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Aleya A MarzukiDepartment of Psychology, University of Cambridge, CambridgeCB2 3EB, UK.
Nuria SegarraCambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Engin KeserDepartment of Psychology, University of Cambridge, CambridgeCB2 3EB, UK.
Akeem SuleDepartment of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Marija FarrugiaCambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Qiang LuoCentre for Computational Psychiatry, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai200433, China.
Naomi FinebergHertfordshire Partnership University NHS Foundation Trust, National Health Service, University of Hertfordshire, Hatfield, UK.
Emilio Fernandez-EgeaBehavioural and Clinical Neuroscience Institute, University of Cambridge, CambridgeCB2 3EB, UK.
Trevor W RobbinsDepartment of Psychology, University of Cambridge, CambridgeCB2 3EB, UK.

Funding

Wellcome Trust
6 · The paper itself

Abstract

backgroundObsessive-compulsive symptoms (OCS) emerge in a significant proportion of clozapine-treated schizophrenia patients, affecting social functioning and increasing depressive symptoms. This study investigates the underexplored cognitive mechanisms of clozapine-induced OCS, particularly focusing on dysfunctional checking behavior.

methodsClinical and cognitive profiles of OCS and their relationship to dysfunctional checking were investigated using a novel checking paradigm (image verification task or IVT) in four groups: clozapine-treated schizophrenia patients with clozapine-induced OCS (SCZ-OCS, n = 21) and without (SCZ-only, n = 15), patients with obsessive-compulsive disorder (OCD, n = 32) and IQ-matched healthy volunteers (HV, n = 30).

resultsOnly SCZ-OCS patients showed a distinctive pattern of dysfunctional checking on the IVT. Compared with SCZ-OCS, SCZ-only patients exhibited functional checking while having equivalent deficits in executive cognition, clozapine dose, and treatment duration, though with less severe positive and depressive symptoms. In SCZ-OCS, dysfunctional checking was positively correlated with clozapine dose and working memory performance. By contrast, OCD patients' checking was positively related to intolerance of uncertainty. Checking in the OCD and SCZ-OCS groups was positively correlated with YBOCS-compulsion.

conclusionThis study is the first to compare the distinct cognitive and clinical profiles of SCZ-OCS, SCZ-only, and OCD, with a focus on checking behavior, a major symptom in clozapine-treated patients. We introduced a novel and sensitive measure for checking, which showed dysfunctional checking only in SCZ-OCS patients treated with clozapine. These findings indicate that a subset of patients with schizophrenia with more severe positive symptoms and cognitive deficits are especially susceptible to OCD symptoms when treated with clozapine.

Indexed as

Antipsychotic AgentsClozapineObsessive-Compulsive DisorderSchizophreniaAdultExecutive FunctionFemaleHumansMaleMiddle AgedAntipsychotic AgentsClozapinecheckingcognitive flexibilityOCDschizophreniaspatial working memory

Identifiers

PMID40098472
PMCPMC12080643

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