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

Abstract

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.

A systematic review of reviews on the prevalence of anxiety disorders in adult populations

“…studies 8 Meta‐analysis: yes Age 10+ 1641 patients with internet addition (IA) and 11,210 controls without IA Postal survey, students, respondents to ads Community settings Mostly Asian samples Standard questionnaires, symptom checklists, interviews Prev of anxiety in IA patients vs normal controls: 23.3% (95% CI: 14.8–34.8) vs 10.3% (5.0–19.9) Anxiety most prev in young age groups with IA (19–39 years highest burden) Other mental and neurological disorders Fajutrao 2009 Search: past 10 years # incl. studies 26 Meta‐analysis: no Patients with bipolar disorder Range: 72–1,631,462 Surveys; general population, inpatients Clinical and community settings European studies DSM diagnoses 13–28% of bipolar patients with anxiety GAD and PD common 70%, 24%, 16% for Italy, France, Germany Amerio 2014 Search: Mar 2013 # incl. studies: 64 Meta‐analysis: no Pop‐based and hospital‐based studies on DSM OCD in bipolar disorder (BD), ages 6 +  Range: 15–1416 Clinical and community settings Most studies conducted in Europe and North America Interviews, DSM criteria Pop‐based US, Italian studies: lifetime prev of OCD in BD: 11.1–21% Hospital‐based studies: lifetime prev: 1.8–35.1% OCD onset usually concomitant with first mood episode Swets 2014 Search: Dec 2009 # incl.…”

“…environmental stress, parenting) Young patients mainly from Asian countries Review Small number of studies Unable to assess how estimates differ with use of self‐reported questionnaires vs. structured interviews 8 Other mental and neurological disorders Fajutrao 2009 Search: past 10 years # incl. studies 26 Meta‐analysis: no Bipolar disorder in Europe Original studies Anxiety assessment and reporting methods diff Retrospective and nonrepresentative samples Review Focus on electronic databases; language selection criteria 5 Amerio 2014 Search: Mar 2013 # incl. studies: 64 Meta‐analysis: no Assess history of mood disorders in OCD patients Treatment research (ex.…”

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

“…[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.…”

“…BD, when comorbid with OCD, has been associated with greater disability and poorer quality of life, 7,8 poor functioning 7,9,10 and higher unemployment 7,9 in comparison to 'pure' OCD or 'pure' BD. It is also associated with episodic course, 11 rapid cycling 8 and more frequent hospitalizations.…”

“…It is also associated with episodic course, 11 rapid cycling 8 and more frequent hospitalizations. 7 Comorbid OCD may increase mortality in BD as studies have consistently shown an increase of suicidal ideas and attempts among patients with BD-OCD. 4,7,8,12 OCD in BD is a poor prognostic factor too, as poor treatment response and polypharmacy are well documented in BD-OCD comorbidity.…”