{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:12:28Z","timestamp":1788959548943,"version":"build-2803163510"},"reference-count":51,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120900_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antipsychotic agents play a paradoxical role in obsessive\u2013compulsive phenomena, augmenting selective serotonin reuptake inhibitors in treatment-resistant obsessive\u2013compulsive disorder yet also inducing or worsening obsessive\u2013compulsive symptoms, mainly in psychotic but also in mood disorders. How strongly individual agents are implicated has not been compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120900_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To map the distribution and density of evidence on antipsychotic-associated obsessive\u2013compulsive symptoms across all agents, including those without induction evidence, and to synthesise causality indicators and management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120900_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A scoping review following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. PubMed\/MEDLINE and Scopus were searched from inception to December 2025, supplemented by two regulatory pharmacovigilance databases (United States FDA Adverse Event Reporting System and World Health Organization VigiBase). Prespecified operational definitions, a four-dimension triangulation framework and a standardised dose metric were applied. Registered on the Open Science Framework (DOI: 10.17605\/OSF.IO\/R8ZFA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120900_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-eight primary studies were included. Clozapine carried the densest, most consistent evidence (de novo prevalence 5.9\u201344.3%; total up to 77.9%); in the one controlled cohort with a drug-free comparator, the number needed to harm for clozapine (at least 6 months) was approximately 4 (95% CI: 2\u20138). Olanzapine and risperidone were intermediate, and predominantly antidopaminergic agents showed minimal literature. Pharmacovigilance placed aripiprazole, not clozapine, highest, discordant with its sparse clinical literature, indicating that the gradient partly reflects research concentration. Genetic associations supported a serotonergic\u2013glutamatergic framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120900_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Evidence for inducing obsessive\u2013compulsive symptoms varies across antipsychotics, being most consistent for clozapine and least for predominantly dopamine-blocking agents. Brief routine screening and a pragmatic response pathway may be considered in clozapine services, with vigilance for other agents as evidence accrues.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12090","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:04:37Z","timestamp":1788959077000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Antipsychotic-associated obsessive\u2013compulsive symptoms and disorder: scoping review of mechanisms, comparative epidemiology and clinical implications"],"prefix":"10.1192","volume":"12","author":[{"given":"Muhanad","family":"Elnoor","sequence":"first","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1190-7613","authenticated-orcid":false,"given":"Syed Ali","family":"Bokhari","sequence":"additional","affiliation":[{"name":"Al Amal Psychiatric Hospital, Emirates Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6467-8150","authenticated-orcid":false,"given":"Syed Fahad","family":"Javaid","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01km6p862","id-type":"ROR","asserted-by":"publisher"}],"name":"College of Medicine and Health Sciences, United Arab Emirates University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"S2056472426120900_ref22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0043-116492","article-title":"Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017","volume":"51","author":"Hiemke","year":"2018","journal-title":"Pharmacopsychiatry"},{"key":"S2056472426120900_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2005.11.030"},{"key":"S2056472426120900_ref31","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11m07164"},{"key":"S2056472426120900_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2004.03.011"},{"key":"S2056472426120900_ref37","doi-asserted-by":"publisher","DOI":"10.1136\/bcr.11.2011.5161"},{"key":"S2056472426120900_ref14","unstructured":"14 National Institute for Health and Care Excellence. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e233"}}