Antipsychotic-Associated Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder: A Scoping Review of Mechanisms, Comparative Epidemiology, and Clinical Implications

This project is a scoping review that maps and synthesizes the human evidence on obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) emerging during antipsychotic exposure, with particular attention to second-generation antipsychotics and clozapine. Antipsychotic medications are used to treat psychotic and mood disorders and, in selected cases, as augmentation for treatment-resistant OCD; however, multiple study designs (case reports/series, cross-sectional studies, cohorts, pharmacovigilance analyses, and clinical trials reporting adverse events) suggest that antipsychotic treatment can be associated with new-onset OCS, exacerbation of pre-existing OCS, or syndromic OCD. The purpose of this review is to: (1) map the scope and distribution of evidence across antipsychotic agents and study designs; (2) characterize clinical phenomenology and indicators supporting a causal relationship (including time to onset, dose at onset, and dechallenge/rechallenge patterns); and (3) summarize reported management strategies and outcomes (for example, dose reduction, switching antipsychotics, selective serotonin reuptake inhibitor addition, cognitive behavioral therapy, and other approaches). Evidence will be identified through searches of major bibliographic databases, targeted grey literature sources (including pharmacovigilance resources where applicable), and forward/backward citation searching. Two reviewers will screen and chart data using a standardized extraction framework; findings will be synthesized descriptively via evidence mapping tables and narrative synthesis. Because this is a scoping review, formal risk-of-bias assessment will not be used to exclude studies; instead, key limitations will be noted narratively. Expected outcomes include an evidence map by antipsychotic agent, summary of reported prevalence/signal patterns by evidence type, and identification of major gaps (for example, inconsistent outcome definitions, limited prospective data, and limited evidence for newer agents). The outputs are intended to inform clinical awareness, guide hypothesis generation, and support future systematic reviews or prospective studies on prevention and management of antipsychotic-associated OCS/OCD.