Obsessive-compulsive bipolar comorbidity: focus on children and adolescents

Masi, Gabriele; Perugi, Giulio; Toni, Cristina; Millepiedi, Stefania; Mucci, María; Bertini, Nicoletta; Akiskal, Hagop S.

doi:10.1016/s0165-0327(03)00107-1

Cited by 111 publications

(114 citation statements)

References 39 publications

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“…These data replicate work that has found high levels of BIS sensitivity in individuals reporting high levels of anxiety (Carver and White, 1994;Gray, 1981). They also support the clinical observation that bipolar adolescents are often highly anxious (Birmaher et al, 2002;Masi et al, 2004).…”

Section: Discussionsupporting

confidence: 86%

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Biuckians

Miklowitz

Kim

2007

Journal of Affective Disorders

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Background-Hypomania/mania and depression are hypothesized to correspond to high and low expressions of behavioral activation system (BAS) activity, respectively, in bipolar individuals. In contrast, behavioral inhibition system (BIS) activity is hypothesized to regulate anxiety. The aim of the present study was to examine whether self-reported levels of BAS functioning in bipolar adolescents corresponded with levels of concurrent manic and depressive symptomatology. The secondary aim was to investigate whether self-reported BIS levels were associated with self-reported anxiety symptoms.

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Section: Discussionsupporting

confidence: 86%

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Biuckians

Miklowitz

Kim

2007

Journal of Affective Disorders

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“…As showed in Table 5, studies conducted in adult and child patients reported that the presence of comorbidity between BD and OCD was associated with poorer functioning and poorer quality of life in all the domains (physical, psychological, social, environmental) vs. patients with 'pure' BD or 'pure' OCD (16,31,39,43,51,62,73). Two hospital-based studies presented similar trends without, although not showing statistically significant differences (65,76).…”

Section: Included Studiesmentioning

confidence: 82%

“…Conversely, three studies showed lower rates of control (53), washing (64,68), ordering, and repeating (64) compulsions in subjects with comorbidity. In the presence of BD, children and adolescents with OCD more frequently were associated with hoarding obsessions and compulsions (43,61,62,72) and ordering (73) compulsions.…”

Section: Included Studiesmentioning

confidence: 98%

“…one report showed that BD-OCD patients were over two times as likely to be also diagnosed with panic disorder, agoraphobia, post-traumatic stress disorder, and eating disorder vs. patients without comorbidity (51). When assessed in child and adolescent populations, higher rates of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and lower rates of generalized anxiety disorder were reported in BD-OCD patients as compared to non-comorbid patients (62,73). Only one study conducted in Italy assessed Axis II comorbidities comparing BD-OCD and non-BD-OCD patients; it reported higher rates of at least one Cluster A personality disorder, at least one Cluster B personality disorder, and narcissistic and antisocial personality disorder in subjects with comorbidity (49).…”

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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“…Possibly, the increased incidence of mood disorders in the child's family makes the child more likely to be exposed to events beyond his or her control. The occurrence of uncontrolled stressful events may account in part for the high rates of anxiety comorbidity observed among childhood bipolar patients (e.g., Masi et al, 2004). Dienes, Hammen, Henry, Cohen, & Daley (2006), in a study of 58 bipolar I adults evaluated every 3 months for one year, found that childhood adversity moderated the association between life stress and recurrence among bipolar adults.…”

Section: The Role Of Stress and Early Adversity In Illness Onset And mentioning

confidence: 99%

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Miklowitz

Chang

2008

Dev Psychopathol

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This article examines how bipolar symptoms emerge during development, and the potential role of psychosocial and pharmacological interventions in the prevention of the onset of the disorder. Early signs of bipolarity can be observed among children of bipolar parents and often take the form of subsyndromal presentations (e.g., mood lability, episodic elation or irritability, depression, inattention, and psychosocial impairment). However, many of these early presentations are diagnostically nonspecific. The few studies that have followed at-risk youth into adulthood find developmental discontinuities from childhood to adulthood. Biological markers (e.g., amygdalar volume) may ultimately increase our accuracy in identifying children who later develop bipolar I disorder, but few such markers have been identified. Stress, in the form of childhood adversity or highly conflictual families, is not a diagnostically-specific causal agent but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. A preventative family-focused treatment for children with (a) at least one first-degree relative with bipolar disorder, and (b) subsyndromal signs of bipolar disorder, is described. This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder.

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Obsessive-compulsive bipolar comorbidity: focus on children and adolescents

Cited by 111 publications

References 39 publications

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

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

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

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