Effect of Risperidone and Olanzapine on obsessive compulsive symptoms in patients with schizophrenia

Author(s):

Ragini Patil, Tushar Patil, Mukund Ganeriwal

Aims and Objectives: To evaluate the response to treatment with antipsychotic drugs in both OC symptoms as well as underlying schizophrenia, in patients with schizophrenia who have obsessive compulsive disorder/symptoms. Material & Methods: All newly diagnosed cases of schizophrenia as per ICD10 criteria by the consultant psychiatrist were included in study. Patient enrollment, data collection and follow-up were done over a period of 12 months and data analysis was done over next 6 months. This was a prospective observational study which also evaluated the response to treatment with medications and follow up was done 12 weeks after initiation of treatment in each patient. All the patients who were diagnosed as schizophrenia, and those who were drug naïve, were subjected to inclusion criteria. The clinical features of the study patients further carefully analyzed for the presence of obsessive compulsive symptoms / disorder (OCS/D) as per the ICD 10 criteria for obsessive compulsive disorder. The outcome of patients was assessed clinically with PANSS and CGI scores at 12 weeks for all patients. In schizophrenia patients with obsessive compulsive symptoms/ disorder (Group A), the outcome was assessed with the help of YBOCS score at 12 weeks follow up visit. Results: Prevalence of OCD/S in schizophrenia according to our study was 24.7%. Mean baseline total YBOCS score was 23.96 plus or minus 4.06 with mean YBOCS obsessions score being 12.85 plus or minus 5.28 and mean YBOCS compulsion score being 10.92 plus or minus  5.22. Severe OC symptoms were in 65.38% and 34.61% had moderate OC symptoms. The mean baseline PANSS score was 53.4 plus or minus  13.5 in patients with OCD-schizophrenia and 53.6 plus or minus 10.4 in patients with only schizophrenia. Both atypical antipsychotic drugs risperidone and olanzapine were equally effective in controlling OC symptoms in these patients as indicated by the significant p values (p<0.001). At the end of 3 months treatment with atypical antipsychotics the mean PANSS positive symptom score for group A was 12.2plus or minus  2.6 and for group B was 12.1 plus or minus 3 which had no statistical difference (U=993.5, p=0.802) and the negative symptom score for group A patients was 8.6 plus or minus  3.9 and for group B patient was 9.5 plus or minus 4.9 which also had no statistical significance (U=979.5, p=0.626). There was a statistically significant difference seen in the mean scores with a reduction in the scores at the end of 3 months for both the groups (t 15.714,p<0.001.;t 16.624 p<0.001) respectively. Hence both the groups had more or less same severity despite the psychopathology of OCS in Group A patients both the groups had better improvement at the end of three months of treatment with no statistical difference(u=810,p=0.064) in two groups. Conclusion: The prevalence of OCD in schizophrenia was 24.7% .At the end of 3 months there was a marked reduction in obsessive compulsive symptoms on YBOCS on treatment with both Risperidone and Olanzapine.