Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
Acta Psychiatr Scand. 2021 Dec;144(6):589-598. doi: 10.1111/acps.13375. Epub 2021 Oct 4.
A substantial proportion of patients with schizophrenia suffer from comorbid obsessive-compulsive disorder (OCD) possibly associated with antipsychotics. However, little is known about the comparative risks of the antipsychotics. The present study aimed to investigate the risk of new-onset OCD following the initiation of different antipsychotic medications for schizophrenia relative to haloperidol.
Using the Korean national claims data, patients aged 15-60 years newly diagnosed with schizophrenia between 2010 and 2018 were identified. Of the 47,808 patients with schizophrenia treated with nine commonly prescribed antipsychotics, 775 new-onset OCD patients were matched to 3,100 patients without OCD using nested case-control design with 1:4 case-control matching based on the sex, age of index date, date of schizophrenia diagnosis, observation period, locations of medical institutions, and level of medical facilities. Using multivariable conditional logistic regression analysis, odd ratios (ORs) for new-onset OCD comparing each antipsychotic agent relative to haloperidol were computed.
The risk for new-onset OCD during treatment with clozapine was significantly higher than that with haloperidol (adjusted OR 2.86; 95% confidence interval [1.63-5.03]). The risks for new-onset OCD with other antipsychotics were not significantly different from that with haloperidol. In subgroup analysis, the early and intermediate, but not late-onset schizophrenia group showed significant risk for OCD associated with clozapine use.
The present findings, based on real-world national representative data, provide reliable evidence for the risk of new-onset OCD in patients with schizophrenia receiving clozapine at a population level.
相当一部分精神分裂症患者合并存在强迫症（OCD），这种情况可能与抗精神病药物有关。然而，人们对于各种抗精神病药物的相对风险知之甚少。本研究旨在调查与氟哌啶醇相比，不同抗精神病药物治疗精神分裂症后新发 OCD 的风险。
利用韩国国家索赔数据，确定 2010 年至 2018 年间被诊断为精神分裂症且年龄在 15-60 岁之间的新发病例。在接受九种常用抗精神病药物治疗的 47808 例精神分裂症患者中，通过嵌套病例对照设计，根据性别、索引日期年龄、精神分裂症诊断日期、观察期、医疗机构位置和医疗机构级别，对 775 例新发 OCD 患者和 3100 例无 OCD 患者进行 1:4 病例对照匹配，采用多变量条件逻辑回归分析，计算与氟哌啶醇相比，每种抗精神病药物治疗精神分裂症时新发 OCD 的比值比（OR）。
氯氮平治疗期间新发 OCD 的风险明显高于氟哌啶醇（调整后的 OR 2.86；95%置信区间 [1.63-5.03]）。与氟哌啶醇相比，其他抗精神病药物治疗精神分裂症时新发 OCD 的风险无显著差异。在亚组分析中，早期和中期而非晚期精神分裂症患者使用氯氮平后 OCD 的发生风险显著升高。
本研究基于真实世界的全国代表性数据，为精神分裂症患者接受氯氮平治疗时 OCD 新发病例的风险提供了可靠的人群水平证据。
