Les symptômes obsessionnels et compulsifs (SOC) sont fréquents, dans la schizophrénie, et semblent aggraver le pronostic. Plusieurs études de cas suggèrent l'apparition ou l'aggravation des SOC lors de traitements neuroleptiques atypiques (rispéridone, olanzapine et clozapine). Il semble donc souhaitable de rechercher des antécédents familiaux ou personnels de SOC avant d'initier un tel traitement, et de surveiller l'apparition des SOC après l'avoir instauré. Une grande partie de ces cas concerne la clozapine. En cas d'apparition de SOC sous clozapine, on peut diminuer les doses de clozapine et adjoindre un traitement par inhibiteur du recaptage de la sérotonine. Les travaux actuels suggèrent que les patients souffrant de schizophrénie avec des SOC devraient bénéficier d'un traitement neuroleptique et d'un traitement anti-obsessionnel. Il existe 2 études contrôlées portant sur le traitement des SOC dans la schizophrénie: l'une avec la clomipramine, l'autre avec la fluvoxamine. Toutes 2 ont démontré leur efficacité. Cependant, ces essais comprennent un faible nombre de patients aux caractéristiques hétérogènes.
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