Intrusive violent images as a side effect of clozapine usage

Abstract

Background

The management of Treatment Resistant Schizophrenia is one of psychiatry's biggest challenges, for which clozapine is one of the few indicated treatments. Although its effectiveness, clozapine is not devoid of adverse effects such as Obsessive-Compulsive Symptoms, which can lead to poorer prognosis. Early identification of these symptoms can prevent from inaccurately identifying them as psychotic symptoms, potentially resulting counterproductive therapeutic choices and poorer outcomes

Case Presentation

A 22-year-old man, diagnosed with paranoid schizophrenia, was admitted in a psychiatric ward due to aggravated psychotic symptoms. The symptomatology was resistant to various antipsychotic regimens, so it was decided to begin clozapine titration. The patient fully recovered, but after 1 month he complained of seeing violent images of his mother dead. This phenomenon, for which he had insight, was experienced as ego-dystonic, leading to a diagnosis of obsessive symptoms, in the form of intrusive images. Causality with clozapine was assumed and the dosage was decreased, with a simultaneous add-on with aripiprazole, leading to the full remission of the symptomatology.

Conclusion

Obsessive-Compulsive Symptoms are frequent in patients undergoing clozapine treatments. Its early diagnosis and therapeutic management can decrease the anguish in these individuals, improving prognosis and quality of life.