Clozapine-related obsessive-compulsive symptoms and their impact on wellbeing: a naturalistic longitudinal study

Kaherine Parkin, Shanquan Chen, Marjan Biria, James Plaistow, Helen Beckwith, Isaac Jarratt-Barnham, Nuria Segarra, Yulia Worbe, Naomi Fineberg, Rudolf N Cardinal, Trevor W. Robbins, Emilio Fernandez-Egea

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Obsessive–compulsive symptoms (OCS) are commonly associated with clozapine treatment but are frequently overlooked by clinicians despite their potential impact on patients' quality of life. In this study, we explored whether OCS severity impacted subjective wellbeing and general functioning, independently of depressive and psychotic symptoms.

We used anonymised electronic healthcare records from a large cohort of patients who were treated with clozapine and assessed annually for OCS, wellbeing, general functioning, and psychopathology using standardised scales as part of routine clinical practice. We used statistical mixed linear model techniques to evaluate the longitudinal influence of OCS severity on wellbeing and general functioning.

A total of 184 patients were included, with 527 face-to-face assessments and 64.7% evaluated three or more times. Different linear mixed models demonstrated that OCS in patients treated with clozapine were associated with significantly worse wellbeing scores, independently of depression and psychotic symptoms, but OCS did not impair general functioning. Obsessional thinking and hoarding behaviour, but not compulsions, were significantly associated with the impact on wellbeing, which may be attributable to the ego-syntonic nature of the compulsions.

Given the frequent occurrence of OCS and their negative impact on wellbeing, we encourage clinicians to routinely assess and treat OCS in patients who are taking clozapine.
Original languageEnglish
Pages (from-to)2936-2945
Number of pages10
JournalPsychological Medicine
Issue number7
Early online date13 Jan 2022
Publication statusPublished - 13 May 2023


  • Clozapine
  • obsessive-compulsive disorder (OCD)
  • obsessive-compulsive symptoms (OCS)
  • schizophrenia
  • wellbeing
  • Comorbidity
  • Humans
  • Obsessive-Compulsive Disorder/drug therapy
  • Schizophrenia/epidemiology
  • Antipsychotic Agents/adverse effects
  • Psychiatric Status Rating Scales
  • Clozapine/adverse effects
  • Quality of Life
  • Longitudinal Studies


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