Clinical expression of obsessive-compulsive disorder in women with bipolar disorder

Issler, Cilly Klüger; Amaral, José Antônio; Tamada, Renata Sayuri; Schwartzmann, Angela Maria; Shavitt, Roseli Gedanke; Miguel, Eurí­pedes Constantino; Lafer, Beny

doi:10.1590/s1516-44462005000200013

Cited by 15 publications

(14 citation statements)

References 23 publications

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“…The findings of this study are consistent with many studies that revealed contamination [46], religious [7] and aggressive [1,46] obsessions are positively associated with BD-OCD comorbidity. However, these findings are inconsistent with some studies which reported more sexual obsessions [1,47] and lower rates of contamination obsessions among patients with BD-OCD comorbidity [1,48].…”

Section: Description Of Oc Symptomssupporting

confidence: 92%

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Pattern of Obsessive Compulsive Symptoms among Patients with Bipolar-I Disorder

Rabie¹,

Shorub²,

Al-awady³

et al. 2016

J Depress Anxiety

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Background: Clinicians have observed the occurrence of obsessive and/or compulsive symptoms within the course of bipolar disorder. However the pattern of their occurrence is not clearly delineated. This study aimed to explore this pattern.Method: A cross sectional study. All patients were assessed by the Structured Clinical Interview for DSM-IV (SCID I) to diagnose bipolar disorder (BD) and comorbid obsessive compulsive (OC) symptoms. The symptom severity was assessed by Young Mania Rating Scale (YMRS), Beck Depression Inventory II (BDI-II), Yale-Brown Obsessions and compulsions Scale (Y-BOCS).Results: Sixty two patients were classified into two groups: BD comorbid with OC symptoms (BD-OC) and BD with no comorbidity (BD). High rates of OC symptoms in BD patients (38.7%) with higher educational level in the BD-OC group, and higher rates of unemployment were noticed among patients of BD-OC group. The smoking was more prevalent in BD group than BD-OC group. The most common among BD-OC subjects were contamination, religious and aggressive obsessions and cleaning/washing and counting compulsions. Limitations:The prevalence rates are not to be generalized because of the small size of the sample. Most of the history was taken from the patients and their relatives depending on their memory. More experimental study designs about the effectiveness of different types of management strategies would be beneficial to the patients. Conclusion: Bipolar Patients with comorbid Obsessive and/orCompulsive symptoms showed higher educational levels, unemployment, greater functional impairment, and less smoking. Most common obsessions were contamination, religious and aggressive obsessions, cleaning and counting compulsions. bipolar and OCD and those with just OCD. Those with pure OCD have more checking compulsions while those with comorbidity exhibit more obsessions that are classified as "others" which they described as "existential, philosophical, and/or superstitious". In general they found that although the amount of obsessions were equal whether comorbid or not, those who also had bipolar disorder actually had fewer compulsions [13].Those with comorbid bipolar disorder and obsessive-compulsive disorder typically experience heightened feelings of distress over those with only one of the disorders. This is not unique to comorbid OCD and bipolar disorder; comorbidity in general is typically reflected by increased levels of distress and increased treatment [18]. For those with comorbid OCD and bipolar disorder, there is also an increased risk for alcohol and substance abuse [19].A group of researchers has looked at how OCD and bipolar relate. They found that whereas unipolar depression was "incidental", i.e. not clearly related to the OCD (although common) by contrast bipolar disorder seemed to be more directly related to the OCD. For example, people with religious and sexual obsessions as part of their OCD were more likely than those with other obsessions to have bipolar disorder. The authors specifically recommend that bip...

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Section: Description Of Oc Symptomssupporting

confidence: 92%

“…These findings are consistent with many studies that revealed that patients with comorbidity were reported to have higher rates of cleaning [46], and counting [49] compulsions. However, they are inconsistent with studies that showed lower rates of washing compulsions in subjects with BD-OC comorbidity [1,44].…”

Section: Description Of Oc Symptomssupporting

confidence: 92%

Pattern of Obsessive Compulsive Symptoms among Patients with Bipolar-I Disorder

Rabie¹,

Shorub²,

Al-awady³

et al. 2016

J Depress Anxiety

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“…In BD patients, OCD comorbidity manifested more likely during mixed mania and depression episodes (66,67). Sexual (49,53,55,68), symmetry (69-71), aggressive (68,70), religious (53,68), contamination (70), and hoarding (49) obsessions were positively associated with BD-OCD comorbidity. In addition, three studies reported lower rates of somatic and contamination obsessions and pathological doubt in patients with comorbidity as compared to non-comorbid patients (65,68,71).…”

Section: Included Studiesmentioning

confidence: 98%

“…With regard to compulsions, patients with comorbidity were reported to have higher rates of order (55,(69)(70)(71), control/checking (70) and repeating (49,69) rituals, pathological slowness (65), reassurance seeking (65), cleaning (70), and counting (69) compulsions. Conversely, three studies showed lower rates of control (53), washing (64,68), ordering, and repeating (64) compulsions in subjects with comorbidity.…”

Section: Included Studiesmentioning

confidence: 99%

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

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Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review Amerio A, Odone A, Liapis CC, Ghaemi SN. Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review.Objective: At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Defining the nosology of BD-OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. Method: A systematic review was conducted on: i) BD-OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. Results: Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD-OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9 AE 4.2 vs. 4.1 AE 2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). Conclusion: In this first systematic review of BD-OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease. • The evidence so far on BD-OCD nosology-mainly based on the course of illness-supports the view that the majority of cases of comorbid BD-OCD are in fact cases of BD. OC symptoms usually are secondary manifestations of depressive or manic mood episodes.• BD-OCD patients may respond for both groups of symptoms with adequate doses of mood stabilizers and atypical antipsychotics. Because of the risk of worsening BD via SRI-induced mania/hypomania, antidepressants should only be used in a minority of refractory OCD. Considerations• Course of illness is the only diagnostic validator that clearly supports the OCD-BD construct as a subtype of BD. Findings on the phenomenology, heredity, biological markers, and treatment were fragmented and heterogeneous and mainly suggested increased severity of illness or functioning without helping us to answer the nosological question.• The use of retrospective assessment scales with unclear sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations may have biased results toward an overestimation of obsession's prevalence. In addition, small sample sizes, mainly from out-patients units, may have limited the generalizability of the results to a whole community.

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“…9 BD-OCD patients had a higher number of depressive episodes than patients with BD alone, which may be attributed to poor treatment of OCD in BD-OCD due to fear of causing mood instability. 7,18 Only a few studies have analyzed OCD in remitted BD. 5,6 These studies found that OCD-BD subjects were characterized by episodic course of OCD, high familial loading for mood disorders, and comorbidity with depression, social phobia, and generalized anxiety disorder.…”

Section: Introductionmentioning

confidence: 99%

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Kazhungil

Cholakottil

Kattukulathil

et al. 2017

Trends Psychiatry Psychother.

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Introduction Comorbid obsessive-compulsive disorder (OCD) is common in bipolar disorder (BD). Clinical characteristics, functionality and familial pattern of this comorbidity are largely understudied. Objective To assess clinical profile, familial loading of psychiatric disorders and level of functioning in remitted BD patients who have comorbid OCD and to compare results with those of remitted BD patients without OCD. Methods Remitted BD-I subjects were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Family Interview for Genetic Studies (FIGS). BD patients with and without OCD were compared. Group differences were analyzed using the chi-square test and the independent samples t test. Values <0.05 were considered statistically significant. Results Of the 90 remitted BD-I patients, 35.5% (n=32) had obsessive-compulsive symptoms/OCD. The BD-OCD group showed significantly lower GAF scores, higher rates of suicidal attempts, hospitalizations, manic and depressive episodes compared to the group with BD only (p<0.05). In addition, first and second-degree relatives had higher rates of BD-OCD and OCD, but not of BD. Conclusions BD-OCD is characterized by more severe BD, more dysfunction and higher familial loading of BD-OCD and OCD. Larger studies involving relatives of probands will help to confirm our findings and to delineate nosological status of BD-OCD comorbidity.

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Clinical expression of obsessive-compulsive disorder in women with bipolar disorder

Cited by 15 publications

References 23 publications

Pattern of Obsessive Compulsive Symptoms among Patients with Bipolar-I Disorder

Pattern of Obsessive Compulsive Symptoms among Patients with Bipolar-I Disorder

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

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