Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment

Table 2

Therapeutic interventions addressing OCS in schizophrenia.

Early recognition and monitoring
(I)	Definition of at-risk constellations
(II)	Detection of subclinical levels of OCS or beginning cognitive impairment using sensitive sets of neurocognitive tests
(III)	Monitoring of apparent OCS
Add-on of psychotropic agents: polypharmacy
(I)	Augmentation with antidepressants: clomipramine, fluvoxamine, and other SSRIs [level of evidence: RCTs, CS, CR]; Caveat: additive (anticholinergic) side effects and pharmacokinetic interactions
(II)	Augmentation with mood stabilizers (lamotrigine, valproic acid) aiming at a reduction of SGA-dosage to minimally sufficient levels [level of evidence: CS, CR]
(III)	Combination of proobsessive SGAs with neutral or antiobsessive SGAs (amisulpride, aripiprazole) in order to reduce the clozapine dosage to minimally sufficient levels [level of evidence: RCT, CS, CR]
Psychotherapy
	Cognitive behavioural therapy including exposure and response prevention [level of evidence: CS, CR]

Summary of therapeutic approaches for schizophrenia patients with comorbid OCS or OCD. The current level of empirical evidence is indicated in square brackets. CR: case report, CS: case series, and RCT: randomized controlled trial.