Comorbidity of Anxiety Disorder among Patients with Bipolar I Disorder in Remission

Tamam, Lut; Özpoyraz, Nurgül

doi:10.1159/000063824

Cited by 68 publications

(68 citation statements)

References 16 publications

(49 reference statements)

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“…When restricting the analysis to studies with sample size greater than 250, the OCD-BD prevalence range was narrower (3-13.6%) (24,26,27,31,38,39), and the mean prevalence rate of BD-I comorbidity was 15%, while BD-II was 12.6% (24,38,39). 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).…”

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

100

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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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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

100

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“…For example, more than 60% of people with bipolar disorder meet lifetime criteria for an anxiety disorder (Tamam & Ozpoyraz, 2002), and more than 70% meet lifetime criteria for substance abuse or dependence (Kessler et al, 1997). The role of life events in explaining these comorbid patterns remains unknown.…”

Section: Conceptual Integrationmentioning

confidence: 99%

Life events in bipolar disorder: Towards more specific models

Johnson

2005

Clinical Psychology Review

177

165

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This article reviews the evidence concerning life events as a predictor of symptoms within bipolar disorder. First, key methodological issues in this area are described, and criteria used for including studies in this review are defined. Then findings that negative life events predict worse outcomes within bipolar disorder are reviewed. Beyond general studies on relapse, it is important to differentiate predictors of depression from predictors of mania. When severe negative life events occur, they appear to trigger increases in bipolar depression. Nonetheless, many depressions are unrelated to negative life events and appear to be triggered by other variables. The strongest evidence suggests that negative life events do not trigger mania, except perhaps in certain contexts. Retrospective findings for schedule-disrupting life events as a trigger for manic symptoms await further assessment within a longitudinal study. Life events involving goal attainment do appear to trigger manic symptoms. Overall, it is time to differentiate among specific types of life events, as these different forms of events point towards mechanisms linking stressors with symptom expression. These mechanisms provide clues into ways to integrate the social environment with biological vulnerability (see Bipolar disorder is clearly a biological disorder. Nonetheless, over the past 15 years, a wealth of research has made it abundantly clear that psychosocial variables shape outcomes of this disorder. Much of this psychosocial research has focused on whether life events predict the timing and severity of symptoms within this disorder. This paper reviews the evidence that life events are related to symptom expression within bipolar disorder. This basic question has challenged researchers for over 20 years. Given the growing literature, this paper focus on addressing two more specific questions. Which types of symptoms are related to life events? What types of life events influence symptoms? Given the growing number of studies available on these issues, this review will focus on those studies with the most rigorous methodologies. To set the stage for this endeavor, it is important to first review the major methodological issues in research on life events and bipolar disorder, including issues related to design, measurement, and sampling.

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“…[1][2][3] The prevalence of OCD may be masked by presence of manic or depressive symptoms in BD, which is evident from data in remitted patients where the reported prevalence of comorbid OCD is quite high (35 to 38.6%). [4][5][6] In children with BD, the prevalence of OCD ranges between 20.7 and 46.9%. 7 The high prevalence of such association is even argued for a specific subtype of BD or OCD or one disorder increasing the propensity to develop the other.…”

Section: Introductionmentioning

confidence: 99%

“…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. They also had less severe OCD and a different symptom profile compared to non-bipolar OCD.…”

Section: Introductionmentioning

confidence: 99%

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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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Comorbidity of Anxiety Disorder among Patients with Bipolar I Disorder in Remission

Cited by 68 publications

References 16 publications

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

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

Life events in bipolar disorder: Towards more specific models

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

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