Obsessive compulsive disorder is an irrepressible need to perform an action, which, if frustrated creates anxiety, even aggressiveness. These actions include pathological gambling, hypersexuality, food obsessions, compulsive buying, etc.

Obsessive compulsive disorder can sometimes be an adverse effect of medication: it is a known adverse effect of dopamine agonists used to treat Parkinson’s disease.

Compulsive disorders have also been observed with atypical neuroleptics such as aripiprazole in particular, quetiapine, olanzapine, and amisulpride. Observations have shown that with these sedative-type drugs, some patients paradoxically become aggressive, insomniac or spend huge sums of money to satisfy their need to gamble or shop, some going so far as to commit theft. An increased libido, masturbation, loss of inhibitions, even acts of paedophilia have been reported, resulting in serious personal and social consequences for the patient and their family.

These disorders occurred a few days or a few months after treatment began, or after an increase in dosage. On stopping or reducing the dosage of the drug, the symptoms were reported to have stopped completely or partially.

If a behavioural disorder occurs or becomes more pronounced in a patient taking a psychotropic drug, it is possible that the drug is the cause. These disorders can be prevented by informing patients and their families of the risk, and healthcare professionals should consider stopping or reducing the dosage or changing to a different drug.

©Prescrire 1 February 2014

"Atypical neuroleptics: compulsive disorders" Prescrire Int 2014; 23 (146): 43-44. (Pdf, subscribers only).