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

Abstract

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.

The impact of MDQ positivity on quality of life impairment: Does it support the hypothesis of “Dysregulation of Mood, Energy, and Social Rhythms Syndrome” (DYMERS)?

“…This data supports the hypothesis that MDQ positivity, by itself, identifies a condition of clinical interest regardless of comorbidity with other disorders. The dimensions explored by the SF-12 (albeit from a subjective perspective) include physical health and functioning, physical pain, vitality, social functioning, emotional condition, and 18 29.5 ± 7.3 7.0 ± 3.5 (N = 201) df 1,238 F = 9.937 p = 0.002 Wilson's disease 19 33.8 ± 9.0 4.4 ± 1.7 (N = 23) df 1,60 F = 0.344 p < 0.568 Carotid atheriosclerosis 20 30.6 ± 8.1 6.2 ± 5.0 (N = 46) df 1,83 F = 1.040 p = 0.311 Major depressive disorder 21 33.8 ± 9.2 5.6 ± 3.6 (N = 37) df 1,73 F = 2.66 p = 0.608 Eating disorders 15 34.0 ± 6.2 4.4 ± 6.6 (N = 60) df 1,97 F = 10.272 p = 0.603 Panic disorders 27 35.5 ± 4.6 2.9 ± 0.9 (N = 123) df 1,160 F = 19.454 p < 0.0001 Obsessive compulsive disorder 22 35.4 ± 6.9 2.9 ± 6.0 (N = 88) df 1,125 F = 3.709 p = 0.056 Post-traumatic stress disorder 23 36.3 ± 6.1 3.9 ± 1.0 (N = 26) df 1,91 F = 1.388 p = 0.243 Simple phobia 28 35.8 ± 6.1 2.5 ± 2.4 (N = 54) df 1,66 F = 10.016 p = 0.002 Agoraphobia 24 35. psychosocial disability. Therefore, these elements are not negligible on a clinical level.…”

The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews

“…For each person with GAD, a cell was created including all the people without GAD in the database of the same age and gender, thus four people for each cell were selected. The burden in impairing of HR-QoL attributable to GAD was also compared to a similar measure obtained to other diseases in previous case-control studies, which were carried out with the same methodology [45][46][47][48][49][50][51].…”

The Burden of Agoraphobia in Worsening Quality of Life in a Community Survey in Italy

“…The findings are consistent with other studies that had seen the co-morbid agoraphobic component affecting the quality of life in a measure not inconsistent with other anxiety disorders [ 36 , 37 ]. Similarly, the impact on quality of life of obsessive-compulsive disorder was found to be influenced by the co-morbidity with bipolar spectrum disorders [ 38 ].…”

“…36,37 Similarly, the impact on quality of life of obsessive-compulsive disorder was found to be influenced by the co-morbidity with bipolar spectrum disorders. 38 However, the attributable burden of agoraphobia is nonnegligible. When compared to the attributable burden of other chronic and disabling conditions in studies that applied the same methodology of this study, the attributable burden of agoraphobia resulted higher than the attributable found in celiac disease, 39 lower than in multiple sclerosis, 40 or in fibromyalgia, 41 but comparable to the one observed for Wilson disease and eating disorders.…”