Clinical characteristics of comorbid obsessive‐compulsive disorder and bipolar disorder in children and adolescents

Abstract

Joshi G, Wozniak J, Petty C, Vivas F, Yorks D, Biederman J, Geller D. Clinical characteristics of comorbid obsessive‐compulsive disorder and bipolar disorder in children and adolescents. Bipolar Disord 2010: 12: 185–195. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective: To explore bidirectional comorbidity between bipolar disorder (BPD) and obsessive‐compulsive disorder (OCD) in youth and to examine the symptom profile and clinical correlates of both disorders in the context of reciprocal comorbidity and ascertainment status. Methods: Two samples of consecutively referred youth (ages 6–17 years) ascertained contemporaneously for respective studies of BPD and OCD were compared using clinical and scalar assessment and structured diagnostic interviews. Results: A total of 21% (17/82) of the BPD subjects and 15% (19/125) of the OCD subjects met DSM‐III‐R diagnostic criteria for both disorders. In the presence of BPD, youth with OCD more frequently experienced hoarding/saving obsessions and compulsions along with a clinical profile of greater comorbidity, poorer global functioning, and higher rate of hospitalization that is characteristic of BPD. Multiple anxiety disorders (≥ 3), especially generalized anxiety disorder and social phobia, were present at a higher frequency when OCD and BPD were comorbid than otherwise. In subjects with comorbid OCD and BPD, the primary disorder of ascertainment was associated with an earlier onset and more severe impairment. Conclusions: An unexpectedly high rate of comorbidity between BPD and OCD was observed in youth irrespective of primary ascertainment diagnosis. In youth with comorbid OCD and BPD, the clinical characteristics of each disorder run true and are analogues to their clinical presentation in youth without reciprocal comorbidity, with the exception of increased risk for obsessions and compulsions of hoarding/saving and comorbidity with other anxiety disorders.

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

“…As showed in Table 5, studies conducted in adult and child patients reported that the presence of comorbidity between BD and OCD was associated with poorer functioning and poorer quality of life in all the domains (physical, psychological, social, environmental) vs. patients with 'pure' BD or 'pure' OCD (16,31,39,43,51,62,73). Two hospital-based studies presented similar trends without, although not showing statistically significant differences (65,76).…”

“…Conversely, three studies showed lower rates of control (53), washing (64,68), ordering, and repeating (64) compulsions in subjects with comorbidity. In the presence of BD, children and adolescents with OCD more frequently were associated with hoarding obsessions and compulsions (43,61,62,72) and ordering (73) compulsions.…”

“…When considering remitted patients, comorbidity prevalence rates were 35% (OCD-BD patients) (41) and 38.6% (OCD-BD-I patients) (42). Studies focusing on prepubertal and adolescent BD subjects reported OCD comorbidity rates ranging between 20.7% and 46.9% (43)(44)(45).…”

“…When restricting the analysis to studies with sample size greater than 250, the BD-OCD prevalence range was narrower (11-15.7%) (17,51,53), and the mean prevalence rate of BD-I comorbidity was 3.7%, while BD-II was 9.5% (17,51,53,58). Hospital-based studies conducted in OCD children and adolescents described prevalence of comorbid BD ranging between 1.8% and 35.8% (43,(59)(60)(61)(62)(63). Only one study differentiated BD comorbidity by type in child and adolescent population (62).…”

“…and pt. with comorbidity Joshi, Wozniak et al 2010 (43) Lower lifetime and current level of functioning on the GAF scale in BD-OCD and OCD-BD pt. vs. pt.…”