Which Antipsychotic is Least Likely to Exacerbate OCD symptoms in “Schizo-Obsessive” Disorder?

Q: Which Antipsychotic is least likely to exacerbate OCD symptoms in patients with Schizo-Obsessive Disorder?



There is growing evidence that patients with comorbid obsessive–compulsive disorder (OCD) and schizophrenia may represent a special category of the schizophrenia population (“Schizo-Obsessive”).

Atypical antipsychotics (Dopamine-Serotonin Antagonist) are more likely to exacerbate Obsessive Compulsive symptoms (OCS), compared to typical antipsychotics.


Atypical antipsychotics (Dopamine-Serotonin Antagonist) blocks 5HT2A receptor in presynaptic dopamine neuron –> disinhibit dopaminergic activity –> postulated to increase OCS in pt with schizophrenia.

Q: Which Antipsychotic is least likely to exacerbate OCD symptoms in this population?



This is an atypical antipsychotic is selective dopamine blocker, with low affinity for 5HT2A receptor –> resultant antiobsessional effects.

Second option after Amisulpride is Aripiprazole.

Aripiprazole is potent 5HT2A antagonist with Partial dopamine agonist –> thus causing relatively weak dopamine D2 blockade –> thus pharmacologically even Aripiprazole can result in excacerbation of OCS symptoms.

However following two studies (small open label prospective study and double blind trial) showed efficacy of Aripiprazole in OCS in schizophrenia.

  1. Sayyah M. Depress Anxiety. 2012;29:850-854.,
  2. Kim SW, Clinc Neuropsychopharmacol 2009;32:243-249.
  3. Also read Psychiatric Annals Oct 2013 issue on Comorbidities in Schizophrenia.

Please do post your questions or comments below. 

Dr. Harvinder Singh, M.D. (Admin)

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