Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders

Issler, Cilly Klüger; Monkul, E. Serap; Amaral, José Antônio; Tamada, Renata Sayuri; Shavitt, Roseli Gedanke; Miguel, Eurí­pedes Constantino; Lafer, Beny

doi:10.1111/j.1601-5215.2010.00457.x

Cited by 16 publications

(20 citation statements)

References 28 publications

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“…This finding is consistent with the clinical observation that cases of OCD in association with BD (including subthreshold manifestations) are the most severe and have a worse course (40,41). The prospective epidemiological Zurich Study, which analyzed two groups of probands from age 20 to 40, one having OCD with BD, the other without, showed more chronic episodes, residual symptoms and previous recurrence of depressive episodes in the comorbid group.…”

Section: Discussionsupporting

confidence: 86%

The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey

et al. 2020

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Background: The impact of the comorbidity between Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder Spectrum (BDS) remains to be clarified. The objective of this study was to examine the lifetime prevalence of OCD, the strength of the association of OCD with comorbid BDS and the role of comorbidity of OCD with BDS in the impairment of health-related quality of life (HRQoL) in an Italian community survey. Methods: The study is a community survey. The sample (N = 2,267; women: 55.3%) was randomly selected after stratification by sex and four age groups from the municipal records of the adult population of one urban, one suburban, and at least one rural area in six Italian regions. Physicians using a semi-structured interview (Advanced Tools and Neuropsychiatric Assessment Schedule, ANTAS-SCID) made Diagnostic and Statistical Manual of Mental Disorders-4th revision (DSM-IV) diagnoses of OCD, Major Depressive Disorder (MDD) and Bipolar Disorder (BD). HR-QoL was measured by the Health Survey Short Form (SF-12). Lifetime Hypomania and subthreshold hypomania were screened by the Mood Disorder Questionnaire (MDQ). BDS was defined as the sum of people shown to be positive for hypomania by the MDQ-with or without a mood disorder diagnosis-plus people with a BD-DSMIV diagnosis even if negative for hypomania at the MDQ. Results: Overall, 44 subjects were diagnosed with OCD, 6 with MDD and 1 with BD. The lifetime prevalence of OCD was 1.8% in men (n = 18) and 2.0% in women (n = 26). MDD with lifetime subthreshold hypomania (i.e., people screened positive at the MDQ, even without diagnosed mania or hypomania at the interview) was associated with OCD (OR = 18.15, CI 95% 2.45-103.67); MDD without subthreshold hypomania (and screened negative at the MDQ) was not (OR = 2.33, CI 95% 0.69-7.01). People with BDS Carta et al. Bipolar Spectrum and Obsessive-Compulsive Disorders were strongly associated with OCD (OR = 10.5, CI 95% 4.90-12.16,). People with OCD and BDS showed significantly poorer HR-QoL than people with OCD without BDS (F = 9.492; P < 0.003). Discussion: The study found a strong association between BDS and OCD. BDS comorbid with OCD was associated with more severe impairment of HR-QoL than OCD without comorbid BDS. Identification of symptoms of hypomania, including subthreshold symptoms, may therefore be important in people with OCD as they might predict a course with poorer HR-QoL.

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Section: Discussionsupporting

confidence: 86%

The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey

et al. 2020

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“…The results of YMRS and BDI-II revealed more severe depression in the BD-OC group with statistically significant difference (p value=0.03) and more severe manic symptoms in the BD group with statistically significant difference (p value=0.01). These findings are consistent with many studies which revealed that the total number of depressive episodes was higher in patients with OCD-BD comorbidity than in BD alone [40,41].…”

Section: Clinical Datasupporting

confidence: 82%

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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“…When diagnosed comorbidly with BD, OCD has been associated with an earlier onset of BD, a higher number of previous mood episodes, rapid cycling, seasonality, substance misuse, and lower overall functioning 732, 737, 738, 739, 740, 741, 742. Jeon et al recently conducted a comprehensive review of patients diagnosed with BD and comorbid OCD and found twice the rate of pharmacological switch to mania or hypomania, but suggested this could be due to the more frequent use of antidepressants in that population 732.…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders

Abstract: Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.

Cited by 16 publications

References 28 publications

The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey

The Burden of Comorbidity Between Bipolar Spectrum and Obsessive-Compulsive Disorder in an Italian Community Survey

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

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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