Comorbidity of obsessive‐compulsive disorder in recovered inpatients with bipolar disorder

Krüger, Stephanie; Bräunig, Peter; Cooke, R.G.

doi:10.1034/j.1399-5618.2000.020111.x

Cited by 77 publications

(63 citation statements)

References 33 publications

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“…In the ECA database, OCD-BD patients had statistically significant higher lifetime rates of 'thoughts of suicide', 'suicide attempts', 'thoughts of death', and 'wanting to die' vs. non-OCD-BD patients (3). These features were confirmed in most recent studies both in OCD-BD patients (31,37,39,75) and in BD-OC syndrome patients (16). OCD also was associated with a 2.4-fold increase in the odds of suicidal ideation among BD adolescents as compared to noncomorbid adolescents (45).…”

Section: Included Studiessupporting

confidence: 80%

“…Three populationbased studies conducted in Italy and USA, reported lifetime prevalence rates of comorbid OCD in BD patients ranging between 11.1% and 21% (3,23,24). In hospital-based studies, the lifetime prevalence of comorbid OCD in BD patients ranged between 1.8% and 35.1% (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) depending on the features of the BD study population included (schizoaffective disorder, bipolar type). 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).…”

Section: Included Studiesmentioning

confidence: 99%

“…and non-OCD-BD pt. in terms of lifetime suicide attempts Kruger et al 2000 (37) Higher (62) More frequent need of hospitalization (62.8% vs. 28.6%) in BD-OCD pt. vs. non-BD-OCD pt.…”

Section: Included Studiesmentioning

confidence: 99%

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

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

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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 Studiessupporting

confidence: 80%

Section: Included Studiesmentioning

confidence: 99%

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

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

View full text Add to dashboard Cite

show abstract

“…When diagnosed comorbidly with BD, OCD has been associated with an earlier onset of BD, a higher number of previous mood episodes, rapid cycling, seasonality, substance misuse, and lower overall functioning 732, 737, 738, 739, 740, 741, 742. Jeon et al recently conducted a comprehensive review of patients diagnosed with BD and comorbid OCD and found twice the rate of pharmacological switch to mania or hypomania, but suggested this could be due to the more frequent use of antidepressants in that population 732.…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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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%

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 obsessive‐compulsive disorder in recovered inpatients with bipolar disorder

Abstract: Our findings suggest that BD-II, OCD, dysthymia, and suicidality cluster together in some subjects with BD. We discuss the clinical implications of our findings.

Cited by 77 publications

References 33 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

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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

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