Table 3.

Therapeutic approaches.

Early recognition and monitoring	Definition of at-risk-constellations.
	Monitoring of subclinical levels of OCS or beginning cognitive impairment using sensitive sets of neurocognitive tests (Schirmbeck et al., 2011, 2012b).
Polypharmacy	Augmentation with antidepressants: Clomipramine, fluvoxamine and other SSRIs. [Level of evidence: RCTs, CS, CR] (Berman et al., 1995b; Poyurovsky et al., 1999b; Reznik and Sirota, 2000).
	Caveat: Additive (anticholinergic) side effects and pharmacokinetic interactions
	Augmentation with mood stabilizers (lamotrigine, valproic acid) aiming at a reduction of SGA-dosage to minimally sufficient levels [Level of evidence: CS, CR] (Zink et al., 2007; Poyurovsky et al., 2010; Rodriguez et al., 2010; Canas et al., 2012).
	Combination of pro-obsessive SGAs with neutral or anti-obsessive SGAs (amisulpride, aripiprazole) in order to reduce the clozapine-dosage to minimally sufficient levels [Level of evidence: RCT, CS, CR].
	(Connor et al., 2005; Zink et al., 2006; Englisch and Zink, 2008; Kim et al., 2008; Yang et al., 2008; Englisch et al., 2009; Muscatello et al., 2011)
Psychotherapy	Cognitive behavioral therapy involving exposure and response prevention [Level of evidence: CS, CR] (Schirmbeck and Zink, 2012; Tundo et al., 2012).

Summary of therapeutic approaches for schizophrenia patients with comorbid OCS or OCD. The current level of empirical evidence is indicated in square brackets.

Abbreviations

CR

case report

CS

case series

RCT

randomized controlled trial.