Comorbid Obsessive-Compulsive Disorder and Bipolar Disorder in the Pediatric Population — Clinical and Therapeutic Challenges

Abstract

Comorbidity between obsessive-compulsive disorder and bipolar disorder has been a well-documented phenomenon in the adult population for several decades. However, scant evidence exists regarding this comorbidity in the juvenile population. The objective of this review is to investigate the impact of obsessive-compulsive disorder and bipolar disorder comorbidity on the clinical course and therapeutic approaches for each disorder individually, with a particular focus on children and adolescents. A scientific review was conducted on a careful analysis of the evidence available on the electronic databases: MEDLINE, Embase and Cochrane Library. In children, it has been observed that up to one-third of individuals diagnosed with either obsessive-compulsive disorder or bipolar disorder also experience a lifetime co-occurrence of the other disorder, a notably higher prevalence when compared to adults. The primary diagnosis typically manifests with an earlier onset in this population. When bipolar disorder is present, children and adolescents with obsessive-compulsive disorder tend to exhibit an episodic course, more hoarding or saving obsessions and compulsions, and a significantly higher number of comorbidities. In this age group, obsessive-compulsive disorder and bipolar disorder comorbidity is further linked to increased severity symptoms, greater impulsivity, reduced responsiveness to pharmacological treatment, elevated suicide risk, and a diminished likelihood of achieving remission rates for manic and depressive symptoms. Obsessive-compulsive symptoms during childhood and adolescence may indicate vulnerability to have bipolar disorder, suggesting partially shared etiopathogenetic mechanisms between these psychiatric entities. The use of antidepressants poses a risk of inducing a switch to mania or rapid cycling in bipolar patients. Additionally, atypical antipsychotics have been reported to trigger and worsen obsessive-compulsive symptoms. The complexity involved in deciding on a suitable treatment scheme for individuals with this comorbidity may contribute to an unfavorable clinical course. A noteworthy portion of comorbid patients may require a combination of multiple mood stabilizers for effective management.