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Nejati A, Bazrafshan A, Mosavat SH. Agomelatine efficacy in treatment resistant obsessive-compulsive disorder: A randomized controlled trial. Int J Psychiatry Med 2024; 59:545-555. [PMID: 38156645 DOI: 10.1177/00912174231225763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a prevalent and burdensome mental health condition, often resistant to conventional treatments. Agomelatine (Valdoxan), a compound acting on serotonin and melatonin systems, has shown promise in treating those with treatment-resistant OCD based on anecdotal reports and case studies. METHODS A randomized, double-blind controlled trial was conducted with 60 patients diagnosed with treatment-resistant OCD. Participants were randomized into an intervention group (receiving agomelatine 50 mg/day) and a control group (receiving placebo). OCD symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) over a 12-week period. RESULTS There were no significant differences in age, gender, or baseline Y-BOCS scores between intervention and control groups. Agomelatine did not demonstrate a significant improvement in OCD symptoms compared to placebo. Adverse events were comparable between groups, and liver enzyme levels remained within the normal range. CONCLUSION This study, while not confirming superior efficacy compared to placebo, underscores the need for continued investigation into agomelatine's potential for treating specific subgroups of OCD patients, underscoring the need for more comprehensive and well-controlled trials in the future.
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Affiliation(s)
- Azadeh Nejati
- Research Center for Psychiatry and Behavioral Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Bazrafshan
- Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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de Filippis R, Aguglia A, Costanza A, Benatti B, Placenti V, Vai E, Bruno E, De Berardis D, Dell’Osso B, Albert U, De Fazio P, Amore M, Serafini G, Ghaemi NS, Amerio A. Obsessive-Compulsive Disorder as an Epiphenomenon of Comorbid Bipolar Disorder? An Updated Systematic Review. J Clin Med 2024; 13:1230. [PMID: 38592113 PMCID: PMC10931838 DOI: 10.3390/jcm13051230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Bipolar disorder (BD) and obsessive-compulsive disorder (OCD) comorbidity is an emerging condition in psychiatry, with relevant nosological, clinical, and therapeutic implications. METHODS We updated our previous systematic review on epidemiology and standard diagnostic validators (including phenomenology, course of illness, heredity, biological markers, and treatment response) of BD-OCD. Relevant papers published until (and including) 15 October 2023 were identified by searching the electronic databases MEDLINE, Embase, PsychINFO, and Cochrane Library, according to the PRISMA statement (PROSPERO registration number, CRD42021267685). RESULTS We identified 38 new articles, which added to the previous 64 and raised the total to 102. The lifetime comorbidity prevalence ranged from 0.26 to 27.8% for BD and from 0.3 to 53.3% for OCD. The onset of the two disorders appears to be often overlapping, although the appearance of the primary disorder may influence the outcome. Compared to a single diagnosis, BD-OCD exhibited a distinct pattern of OC symptoms typically following an episodic course, occurring in up to 75% of cases (vs. 3%). Notably, these OC symptoms tended to worsen during depressive episodes (78%) and improve during manic or hypomanic episodes (64%). Similarly, a BD course appears to be chronic in individuals with BD-OCD in comparison to patients without. Additionally, individuals with BD-OCD comorbidity experienced more depressive episodes (mean of 8.9 ± 4.2) compared to those without comorbidity (mean of 4.1 ± 2.7). CONCLUSIONS We found a greater likelihood of antidepressant-induced manic/hypomanic episodes (60% vs. 4.1%), and mood stabilizers with antipsychotic add-ons emerging as a preferred treatment. In line with our previous work, BD-OCD comorbidity encompasses a condition of greater nosological and clinical complexity than individual disorders.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1205 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI) Lugano, 6900 Lugano, Switzerland
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Eleonora Vai
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Edoardo Bruno
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, 64100 Teramo, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, 20122 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina—ASUGI, 34128 Trieste, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Nassir S. Ghaemi
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Oh S, Cho S, Moon SY, Lee J, Kim M, Lee TY, Kwon JS. Pharmacotherapy for obsessive-compulsive disorder: Real-world evidence from a 10-year retrospective data analysis. Asian J Psychiatr 2024; 91:103847. [PMID: 38029602 DOI: 10.1016/j.ajp.2023.103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
We investigated pharmacotherapy trends for obsessive-compulsive disorder (OCD) patients at a Korean tertiary hospital from 2008 to 2017. Out of 1894 patients, 82.9% received at least one psychotropic medication, with prescription rates increasing over time. The most frequently prescribed drug classes were selective serotonin reuptake inhibitors (SSRIs, 80.5%), anxiolytics (57.5%), antipsychotics (47.2%), other antidepressants (21.1%), and mood stabilizers (18.4%). Combination therapy was administered to 79.7% of medicated patients, with SSRIs, anxiolytics, and antipsychotics being the most common combination. Comorbidities significantly increased the prescription rates of all psychotropic classes (P < 0.001). Our study offers insights that may aid in bridging the gap between OCD treatment guidelines and real-world clinical practice.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, the Republic of Korea; Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Sunwoo Cho
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, SC, USA
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, the Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, the Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Pusan National University Yangsan Hospital, Yangsan, the Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, the Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, the Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, the Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, the Republic of Korea.
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4
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Sesso G, Brancati GE, Masi G. Comorbidities in Youth with Bipolar Disorder: Clinical Features and Pharmacological Management. Curr Neuropharmacol 2023; 21:911-934. [PMID: 35794777 PMCID: PMC10227908 DOI: 10.2174/1570159x20666220706104117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Bipolar Disorder (BD) is a highly comorbid condition, and rates of cooccurring disorders are even higher in youth. Comorbid disorders strongly affect clinical presentation, natural course, prognosis, and treatment. METHODS This review focuses on the clinical and treatment implications of the comorbidity between BD and Attention-Deficit/Hyperactivity Disorder, disruptive behavior disorders (Oppositional Defiant Disorder and/or Conduct Disorder), alcohol and substance use disorders, Autism Spectrum Disorder, anxiety disorders, Obsessive-Compulsive Disorder, and eating disorders. RESULTS These associations define specific conditions which are not simply a sum of different clinical pictures, but occur as distinct and complex combinations with specific developmental pathways over time and selective therapeutic requirements. Pharmacological treatments can improve these clinical pictures by addressing the comorbid conditions, though the same treatments may also worsen BD by inducing manic or depressive switches. CONCLUSION The timely identification of BD comorbidities may have relevant clinical implications in terms of symptomatology, course, treatment and outcome. Specific studies addressing the pharmacological management of BD and comorbidities are still scarce, and information is particularly lacking in children and adolescents; for this reason, the present review also included studies conducted on adult samples. Developmentally-sensitive controlled clinical trials are thus warranted to improve the prognosis of these highly complex patients, requiring timely and finely personalized therapies.
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Affiliation(s)
- Gianluca Sesso
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
| | | | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiat., Calambrone (Pisa), Italy
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Marazziti D, Pozza A. An overview of the pharmacological options for pediatric obsessive-compulsive disorder. Expert Opin Pharmacother 2022; 23:1793-1800. [DOI: 10.1080/14656566.2022.2142779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
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6
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Mancebo MC, Yip AG, Boisseau CL, Rasmussen SA, Zlotnick C. Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center. Behav Ther 2021; 52:1296-1309. [PMID: 34452681 PMCID: PMC8629130 DOI: 10.1016/j.beth.2021.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.
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Affiliation(s)
- Maria C. Mancebo
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA,Corresponding Author: Maria C. Mancebo, Ph.D., Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. Phone:401-455-6216 Fax:401-680-4122
| | | | - Christina L Boisseau
- Butler Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
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Rate of OCD and sub-threshold OCD in bipolar disorder patients with first depressive episode. Psychiatry Res 2021; 302:114010. [PMID: 34091393 DOI: 10.1016/j.psychres.2021.114010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/10/2021] [Indexed: 11/20/2022]
Abstract
Evidence indicates that obsessive-compulsive disorder (OCD) co-occurs with bipolar disorder (BD) at a higher rate than in the general population. Although there is a preliminary indication of a predominant aggregation of OCD in BD patients with bipolar depression (BP-D), no explicit evaluation has previously been undertaken. Using the Structured Clinical Interview for DSM-5 Axis-I disorders and appropriate rating scales, seventy-three BD patients experiencing their first depressive episode were screened for OCD and subthreshold OCD. Nineteen (26%) of the 73 participants in addition to BP-D also met DSM-5 criteria for OCD and 17 (23.2%) patients met criteria for sub-threshold OCD. No differences in demographic and clinical variables evaluated in the study were found between the BP-D patients with and without OCD. Limitations of the study included a relatively small sample size, cross-sectional design and inclusion of only hospitalized BP-D patients. Additional studies are warranted to better define the longitudinal course of comorbid BP-D/OCD, treatment approaches and outcomes of this challenging patient population. Explicit prospective comparison of the rate of DSM-5 OCD and subthreshold OCD in depressive versus manic episodes of bipolar disorder within the same patient is justified.
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Poyurovsky M, Papach P, Weizman A. Beneficial Effect of a Relatively Low Dose of Clozapine in a Bipolar Depression Patient With Comorbid Obsessive-Compulsive Disorder and Severe Suicidality. Clin Neuropharmacol 2021; 43:169-170. [PMID: 32947431 DOI: 10.1097/wnf.0000000000000406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Michael Poyurovsky
- Maale HaCarmel Mental Health Center, Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel Maale HaCarmel Mental Health Center, Tirat Carmel, Israel Felsenstein Medical Research Institute, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel-Aviv University
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9
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Quetiapine for Bipolar Depressive Episode in Obsessive-Compulsive Disorder Patients Maintained on Selective Serotonin Reuptake Inhibitor Treatment. Clin Neuropharmacol 2021; 44:123-125. [PMID: 33811191 DOI: 10.1097/wnf.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A meaningful proportion of patients with obsessive-compulsive disorder (OCD) develop symptoms of bipolar depression (BP-D). In the present investigation, we aimed to determine whether quetiapine is efficacious in OCD patients who despite continuous treatment with a selective serotonin reuptake inhibitor developed an acute episode of BP-D. METHODS We analyzed 68 charts of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition OCD patients from our outpatient clinic and identified 15 patients who in addition met Diagnostic and Statistical Manual of Mental Disorders Fifth Edition criteria for bipolar II disorder, depressive episode. Eleven (7 men and 4 women, aged 24-54 years) patients for whom quetiapine was added to treat the index episode of BP-D were included. Treatment response was assessed retrospectively and defined as a score of "much improved" or "very much improved" on the Clinical Global Impression-Improvement scale. RESULTS Quetiapine was added for treatment of BP-D in a dose range of 150 to 400 mg (mean, 273 mg). Eight (73%) of the 11 study patients fulfilled the criterion of response, that is a score of "much improve" (4 patients) and "very much improved" (4 patients) on the Clinical Global Impression-Improvement scale. Notably, quetiapine was associated with additional improvement of OCD symptoms in 6 of 8 study responders. Quetiapine was well tolerated. The most frequently detected side effects were drowsiness (5 patients), constipation (4 patients), and orthostatic hypotension (2 patients). CONCLUSIONS The revealed beneficial effect of quetiapine addition for acute episode of BP-D in OCD patients maintained on selective serotonin reuptake inhibitor treatment merits further controlled investigation.
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Beneficial effect of quetiapine monotherapy in patients with bipolar depression and comorbid obsessive-compulsive disorder. Int Clin Psychopharmacol 2021; 36:50-53. [PMID: 32784348 DOI: 10.1097/yic.0000000000000325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a prevalent and clinically significant comorbid condition in patients with bipolar disorder. Treatment of bipolar disorder/OCD patients is challenging. We report the results of an open-label, short-term, prospective investigation of quetiapine monotherapy in 16 patients (three men and 13 women, aged 18-56 years) hospitalized for acute bipolar depression who in addition met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for OCD. The participants were treated with quetiapine in a dose range of 150-600 mg (mean 347 mg) for a mean duration of 4.3 ± 1.4 weeks (range 3-7 weeks). Eleven (68.8%) of the 16 study participants fulfilled the predefined criteria for response, namely a score of 'very much improved' (four patients) and 'much improved' (seven patients) on the Clinical Global Impression - Improvement scale. Treatment with quetiapine was associated with a statistically significant decrease from baseline in the relevant rating scales for the assessment of depressive, manic and OCD symptoms. Quetiapine was well tolerated. The most frequently reported side effects were sedation, orthostatic hypotension and constipation. Durability of the positive therapeutic effect of quetiapine monotherapy in patients with bipolar disorder/OCD comorbidity and the necessity for subsequent augmentation with anti-OCD agents need to be addressed in future controlled studies.
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Pharmacological Treatment for Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder in Adults. J Psychiatr Pract 2020; 26:383-393. [PMID: 32936585 DOI: 10.1097/pra.0000000000000499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is fairly common, and the treatment of these conditions when comorbid is challenging. Serotonin reuptake inhibitors, the first option for treatment of OCD, can worsen BD symptoms, and mood stabilizers are generally not efficacious for OCD. Our goal in this article is to assess the clinical effectiveness of pharmacotherapies for comorbid BD-OCD in adults. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases on April 30, 2017, and we also searched the reference lists of identified articles. Studies published beginning January 1, 2007 were included, without language restrictions. Narrative and systematic reviews, letters to the editor, and book chapters were excluded. Two authors independently assessed the quality of the studies and extracted data. Seven studies met our inclusion criteria. Findings from double-blind, randomized, placebo-controlled trials were pooled for analysis. Findings from this pooled analysis indicated that augmentation of mood-stabilizer treatment with glutamate modulator agents (topiramate or memantine) may favor full response of obsessive-compulsive symptoms (risk ratio: 2.62, 95% confidence interval: 1.45-4.74) in patients with BD type I and OCD in the manic phase, and that it does not significantly induce adverse effects (risk ratio: 1.26, 95% confidence interval: 0.53-3.01). Results of a narrative synthesis of observational studies indicated greater efficacy of mood-stabilizer treatment, with serotonin reuptake inhibitors less used. Findings from studies employing different designs were not compared, and our results should be interpreted cautiously.
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12
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Thomson M, Sharma V. Bipolar disorder and musical obsessions. Bipolar Disord 2020; 22:313-315. [PMID: 32198807 DOI: 10.1111/bdi.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Thomson
- Department of Psychiatry, Woodstock General Hospital, Woodstock, ON, Canada.,Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - Verinder Sharma
- Department of Psychiatry, University of Western Ontario, London, ON, Canada.,Parkwood Institute, London, ON, Canada
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Ferentinos P, Preti A, Veroniki AA, Pitsalidis KG, Theofilidis AT, Antoniou A, Fountoulakis KN. Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: Systematic review and meta-analysis of its prevalence. J Affect Disord 2020; 263:193-208. [PMID: 31818777 DOI: 10.1016/j.jad.2019.11.136] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is often comorbid with Bipolar Disorder (BD), complicating its presentation and management. OCD prevalence rates in BD vary widely across studies and recent meta-analyses. OBJECTIVE We performed a comprehensive systematic review and meta-analysis of studies reporting cross-sectional or lifetime OCD prevalence in BD, assessed by meta-regression various determinants of estimated prevalence and compared it with major depressive disorder (MDD) patients and general population subjects included in extracted studies. METHODS Relevant articles published up to January 2019 in PubMed/MEDLINE were retrieved. Prevalence rates underwent Freeman-Tukey double arcsine transformation before meta-analysis. RESULTS We included 29 studies reporting cross-sectional prevalence (N = 6109) and 39 studies reporting lifetime prevalence (N = 8205); eight studies reported both. The pooled lifetime and cross-sectional prevalence of comorbid OCD in BD was estimated at 10.9% (95% CI: 7.8-14.4%) and 11.2% (7.6-15.3%), respectively, in the random-effects model. Respective estimates in the general population were 2.5% and 1.6%. Study setting (epidemiological or clinical), diagnostic criteria and procedures, gender, BD subtype and remission status could not explain heterogeneity of prevalence estimates in meta-regressions. Age had a small yet significant negative correlation with lifetime prevalence. OCD prevalence in BD was not significantly different than in MDD. LIMITATIONS Search was limited to English-language literature. CONCLUSIONS Lifetime OCD prevalence in BD was 4.4 times higher than in the general population. Cross-sectional prevalence was as high as lifetime, suggesting that OCD in BD is more chronic/ persistent than in the general population, where cross-sectional stands at about two thirds the lifetime prevalence.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini street, Athens 12462, Greece.
| | - Antonio Preti
- Genneruxi Medical Center, via Costantinopoli 42, Cagliari 09129, Italy; Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy.
| | - Areti Angeliki Veroniki
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
| | | | - Antonis T Theofilidis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini street, Athens 12462, Greece.
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14
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Step-wise Drug Therapy for Comorbid Bipolar and Obsessive-Compulsive Disorders. Am J Ther 2020; 26:e668-e670. [PMID: 30418229 DOI: 10.1097/mjt.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amerio A, Maina G, Ghaemi SN. Updates in treating comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review. J Affect Disord 2019; 256:433-440. [PMID: 31234022 DOI: 10.1016/j.jad.2019.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/16/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the last five years, the debate around the comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) has flourished within the international psychiatric community and several studies have been published on therapeutic strategies. METHODS An update of our previous systematic review was conducted on clinical management of comorbid BD-OCD patients. Relevant papers published from July 1st 2013 to September 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS Fifteen studies were included. In all selected studies BD-OCD patients received mood stabilizers, alone or with second-generation antipsychotics (SGAs). Aripiprazole augmentation demonstrated to be effective as maintenance therapy and for treating obsessive-compulsive symptoms during manic episodes (40% of the studies, 6/15). Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one case report. LIMITATIONS Almost 50% of the selected studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS Mood stabilization should be the primary goal in treating BD-OCD patients. Aripiprazole augmentation to lithium carbonate seemed to be the best option in treatment-resistance comorbid patients. Addition of SRIs may be needed only in a minority of BD patients with refractory OCD.
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Affiliation(s)
- A Amerio
- Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - G Maina
- Rita Levi Montalcini Department of Neuroscienze, University of Turin, Turin, Italy; San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Department of Psychiatry, Tufts University Medical School, Boston, MA, USA.
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Domingues-Castro MS, Torresan RC, Shavitt RG, Fontenelle LF, Ferrão YA, Rosário MC, Torres AR. Bipolar disorder comorbidity in patients with obsessive-compulsive disorder: Prevalence and predictors. J Affect Disord 2019; 256:324-330. [PMID: 31201983 DOI: 10.1016/j.jad.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) often present with comorbidities, mainly anxiety and affective disorders, which may influence OCD course, help-seeking and treatment response. Some authors have studied bipolar disorder (BD) comorbidity in patients with OCD, but usually in small samples. The objective was to estimate the lifetime prevalence of BD in a large clinical sample of OCD patients, and to compare demographic and clinical features of patients with and without BD comorbidity. METHOD This cross-sectional study with 955 adult OCD patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC) used several assessment instruments, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Descriptive and bivariate analyses were followed by logistic regression. RESULTS The lifetime prevalence of BD was 7.75% (N = 74). The variables that were independently associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders, and suicide attempts. LIMITATIONS The cross-sectional design does not permit causal inferences; the external validity may be limited, as the participants were from tertiary services. Despite the large sample size, some analyses may have been underpowered due to the relatively low prevalence of the outcome and of some explanatory variables. CONCLUSIONS Patients with OCD comorbid with BD have some clinical features indicative of greater severity, including higher suicide risk, and require a careful therapeutic approach for the appropriate treatment of both disorders.
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Affiliation(s)
- Mariana S Domingues-Castro
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil
| | - Ricardo C Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, University of São Paulo (USP), Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro, D'Or Institute for Research and Education, Brazil; Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Maria C Rosário
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Brazil
| | - Albina R Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil.
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17
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Daniel L C Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Personalized and precision medicine as informants for treatment management of bipolar disorder. Int Clin Psychopharmacol 2019; 34:189-205. [PMID: 30932919 DOI: 10.1097/yic.0000000000000260] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
DSM-5 diagnostic categories, defined by a set of psychopathological symptoms are heterogeneous conditions that may include different biological entities, with distinct etiopathogenesis, different courses and requiring different treatment management. For bipolar disorder the major evidences for this lack of validity are the long paths before a proper diagnosis, the inconsistence of treatment guidelines, the long phases of pharmacological adjustment and the low average of long-term treatment response rates. Personalized medicine for mental disorders aims to couple established clinical-pathological indexes with new molecular profiling to create diagnostic, prognostic and therapeutic strategies precisely tailored to each patient. Regarding bipolar disorder, the clinical history and presentation are still the most reliable markers in stratifying patients and guiding therapeutic management, despite the research goes to great lengths to develop new neuropsychological or biological markers that can reliably predict individual therapy effectiveness. We provide an overview of the advancements in personalized medicine in bipolar disorder, with particular attention to how psychopathology, age at onset, comorbidity, course and staging, genetic and epigenetic, imaging and biomarkers can influence treatment management and provide an integration to the conventional treatment guidelines. This approach may offer a new and rational path for the development of treatments for targeted subgroups of patients with bipolar disorder.
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Goldberg JF. Complex Combination Pharmacotherapy for Bipolar Disorder: Knowing When Less Is More or More Is Better. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:218-231. [PMID: 32047367 PMCID: PMC6999211 DOI: 10.1176/appi.focus.20190008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Combination pharmacotherapy for bipolar disorder is commonplace and often reflects the severity and complexity of the illness and the comorbid conditions frequently associated with it. Across treatment settings, about one-fifth of patients with bipolar disorder appear to receive four or more psychotropic medications. Practice patterns often outpace the evidence-based literature, insofar as few systematic studies have examined the efficacy and safety of two or more medications for any given phase of illness. Most randomized trials of combination pharmacotherapy focus on the utility of pairing a mood stabilizer with a second-generation antipsychotic for prevention of either acute mania or relapse. In real-world practice, patients with bipolar disorder often take more elaborate combinations of mood stabilizers, antipsychotics, antidepressants, anxiolytics, stimulants, and other psychotropics for indefinite periods that do not necessarily arise purposefully and logically. In this article, I identify clinical factors associated with complex combination pharmacotherapy for patients with bipolar disorder; describe approaches to ensuring that each component of a treatment regimen has a defined role; discuss the elimination of unnecessary, ineffective, or redundant drugs in a regimen; and address complementary, safe, rationale-based drug combinations that target specific domains of psychopathology for which monotherapies often provide inadequate benefit.
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Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City
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20
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Amerio A, Odone A, Ghaemi SN. Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review. J Affect Disord 2019; 249:15-19. [PMID: 30743017 DOI: 10.1016/j.jad.2019.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/20/2019] [Accepted: 02/05/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry, but treatment of BD-OCD remains a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS A systematic review was conducted on aripiprazole augmentation in treating comorbid BD-OCD patients. Relevant papers published through August 31st 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS Aripiprazole augmentation to mood stabilizers (lithium carbonate, valproate), even at low doses (10-15 mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms. Aripiprazole was generally safe and well tolerated. LIMITATIONS Most studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability. CONCLUSIONS Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that aripiprazole augmentation to mood stabilizers, even at low doses, is effective in BD-OCD patients.
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Affiliation(s)
- A Amerio
- Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - A Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Department of Psychiatry, Tufts University Medical School, Boston, MA, USA.
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21
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Spoorthy MS, Chakrabarti S, Grover S. Comorbidity of bipolar and anxiety disorders: An overview of trends in research. World J Psychiatry 2019; 9:7-29. [PMID: 30631749 PMCID: PMC6323556 DOI: 10.5498/wjp.v9.i1.7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/04/2018] [Accepted: 12/05/2018] [Indexed: 02/05/2023] Open
Abstract
Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder (BD), but it also adversely impacts the course, outcome, and treatment of BD. The present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses (n = 103), epidemiological surveys, and large-scale clinical studies. The results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of time. All types of anxiety disorders were equally common in BD. However, there was a wide variation in rates across different sources, with most of this discrepancy being accounted for by methodological differences between reports. Comorbid anxiety disorders negatively impacted the presentation and course of BD. This unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of BD. Despite the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in BD. Nevertheless, the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.
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Affiliation(s)
- Mamidipalli Sai Spoorthy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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22
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Amerio A, Tonna M, Odone A. Clinical management of comorbid bipolar disorder and obsessive-compulsive disorder: A case series. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:581-584. [PMID: 30657129 PMCID: PMC6502106 DOI: 10.23750/abm.v89i4.7621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressantsare the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined. METHODS Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants. RESULTS In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressantand improvement of affective and obsessive-compulsivesymptoms with mood stabilizers and atypical antipsychotics. CONCLUSIONS Osler's view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasible.
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Affiliation(s)
- Andrea Amerio
- Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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23
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Amerio A, Odone A. Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder. Gen Psychiatr 2018; 31:e100007. [PMID: 30582130 PMCID: PMC6234965 DOI: 10.1136/gpsych-2018-100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/03/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder (BD) since the gold standard treatment for one disease (antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessive-compulsive symptoms with remarkable improvement in social and occupational functioning for 24 months. Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines, which are greatly needed in patients with comorbid BD-OCD.
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Affiliation(s)
- Andrea Amerio
- Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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24
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Abstract
Anxiety disorders are the most prevalent comorbid diagnoses in patients with bipolar disorder (BD). A comorbid anxiety diagnosis can significantly impact the severity of bipolar symptoms, increase the risk of suicidality, and decrease psychosocial functioning and quality of life. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force published recommendations for treatment in 2012 suggesting that specific anticonvulsant mood stabilizers and second-generation antipsychotics are the medications of choice to treat these comorbidities. Serotonergic antidepressant medications are first-line medications for the treatment of most anxiety disorders; however, this can be problematic for a patient with BD. Antidepressant use in BD has been associated with a risk of manic switch as well as potential destabilization of mood. Mood stabilizer therapy should be established for patients with comorbid BD and an anxiety disorder before other medications are added to address the anxiety disorder. While benzodiazepine medications are recommended as third-line therapy in the CANMAT task force recommendations, their use should be avoided in patients with comorbid BD, posttraumatic stress disorder, and substance use disorders. The use of benzodiazepines should in general be avoided for all patients if possible, based upon current clinical research. Interpersonal, cognitive behavioral, and relaxation therapy are effective for the treatment of anxiety symptoms, especially emotional experiences, in patients who are euthymic.
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Affiliation(s)
- Carol A Ott
- (Corresponding author) Clinical Professor of Pharmacy Practice, Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, Indiana; Clinical Pharmacy Specialist, Outpatient Psychiatry, Prevention and Recovery Center for Early Psychosis, Mood Disorders Clinic, Midtown Community Mental Health, Eskenazi Health, Indianapolis, Indiana,
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25
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. 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. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 952] [Impact Index Per Article: 158.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
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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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Jeon S, Baek JH, Yang SY, Choi Y, Ahn SW, Ha K, Hong KS. Exploration of comorbid obsessive-compulsive disorder in patients with bipolar disorder: The clinic-based prevalence rate, symptoms nature and clinical correlates. J Affect Disord 2018; 225:227-233. [PMID: 28841485 DOI: 10.1016/j.jad.2017.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/26/2017] [Accepted: 08/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comorbidity of bipolar disorder (BD) and obsessive-compulsive disorder (OCD) has received clinical attention. However, the detailed nature and nolosogic validity of the comorbidity have not been fully explored. This study investigated the comorbidity rate, clinical nature, and correlates of OCD in patients with BD. METHODS Patients (n = 314) with BD were recruited and lifetime clinical characteristics were evaluated comprehensively. The comorbid OCD ('OCD-BD') group and the 'non-OC BD' group were compared in terms of the clinical variables of BD. RESULTS OCD was found in 15.9% of patients. Earlier age at onset, more frequent pharmacological (hypo)manic switch and a higher rate of comorbid panic disorder were associated with comorbid OCD. In two-thirds (65.4%) of the OCD-BD subjects, obsessive-compulsive symptoms worsened or were confined to depressive episodes. Contamination obsession and checking compulsion were the most common types of obsessive-compulsive symptoms. Drug-induced (hypo)manic switch was observed in more than 60% of the OCD-BD subjects who were previously exposed to antidepressants. None of the OCD-BD subjects were taking antidepressants for OCD in the current specialty clinics. LIMITATIONS Subject recruitment from specialty clinics, retrospective and cross-sectional evaluation, and difficulties in clarifying the causal relationships. CONCLUSIONS The comorbidity rate of OCD in Korean BD patients was comparable to that of Caucasian patients. Even though OCD seems to be more often linked to depressive episodes, a heterogeneous nosologic relationship including a possibility of drug-mediated induction is suggested.
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Affiliation(s)
- Sehyun Jeon
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - So Yung Yang
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yujin Choi
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Sung Woo Ahn
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea.
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Marazziti D, Albert U, Dell'Osso B, Tundo A, Cuniberti F, Maina G, Moroni I, Benatti B, Mucci F, Massimetti G, Piccinni A, Brakoulias V. Italian prescribing patterns in obsessive-compulsive disorder. Hum Psychopharmacol 2017; 32. [PMID: 28967153 DOI: 10.1002/hup.2641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023]
Abstract
The aim of the present study was to investigate psychopharmacological prescribing patterns in a large sample (n = 1815) of patients suffering from obsessive-compulsive disorder (OCD) recruited in 4 Italian centers specialized in OCD, in comparison to available national and international guidelines. The centers were asked to complete a specific data sheet questionnaire on patients' therapeutic status. Statistical analyses were carried out by SPSS. The results showed that almost all patients referred to the centers of Milan, Pisa and Rome received psychotropic medications, whereas only 59.9% (313) did so in Turin. Selective serotonin reuptake inhibitors were the most used drugs ranging between 49.0% and 71.5%. Clomipramine was prescribed more often in Rome and Pisa than in Milan and Turin. The same was true for other tricyclic antidepressants. Second-generation antipsychotics were more often prescribed in Pisa and in Milan. Mood stabilizers were almost exclusively used in Pisa. Taken together, the overall findings would suggest that, although the main Italian centers specialized in OCD follow available guidelines, a certain degree of variability does exist. This may depend on the different educational background, availability of other specific therapeutic strategies, as well as varying levels of severity and comorbidity of the patients.
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Affiliation(s)
- Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Umberto Albert
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Dell'Osso
- Dipartimento di Fisiopatologia-Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Francesco Cuniberti
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Turin, and San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Ilenia Moroni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Beatrice Benatti
- Dipartimento di Fisiopatologia-Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
| | - Federico Mucci
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Armando Piccinni
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Vlasios Brakoulias
- Department of Psychiatry, Sydney Medical School Nepean, The University of Sydney, Sydney, NSW, Australia
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Memantine as an Adjuvant Treatment for Obsessive Compulsive Symptoms in Manic Phase of Bipolar Disorder: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Clin Psychopharmacol 2017; 37:246-249. [PMID: 28099183 DOI: 10.1097/jcp.0000000000000651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE/BACKGROUND The aim of this study is to examine the effects of memantine as an adjuvant treatment for obsessive compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase. METHODS/PROCEDURES In this 16-week double-blind placebo-controlled randomized clinical trial, 58 patients in the manic phase of BD who had OC symptoms were randomly allocated to receive memantine or placebo plus their routine medications (lithium + olanzapine + clonazepam). The Yale Brown Obsessive Compulsive Behavior Scale was used to assess the outcomes. Adverse effects were also recorded. FINDINGS/RESULTS Thirty-eight patients (19 in the memantine group and 19 in the placebo group) completed the trial. Throughout the trial, the mean score decreased from 20.26 ± 5.91 to 9.73 ± 5.44 in the memantine group (P < 0.000) and from 22.89 ± 5.70 to 16.63 ± 4.00 in the placebo group (P < 0.000). At the end of the study, 15 (78.94%) patients in the memantine group and 7 (36.84%) patients in the placebo group demonstrated more than 34% decline in the Yale Brown Obsessive Compulsive Behavior Scale score (P < 0.01). No serious adverse effects were reported. IMPLICATIONS/CONCLUSIONS Our double-blind controlled clinical trial showed that memantine is an effective adjuvant agent for reducing OC symptoms in patients with BD. However, it needs to be noted that our study is preliminary, and larger double-blind controlled studies are needed to confirm the results.
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Saraf G, Paul I, Viswanath B, Narayanaswamy JC, Math SB, Reddy YCJ. Bipolar disorder comorbidity in patients with a primary diagnosis of OCD. Int J Psychiatry Clin Pract 2017; 21:70-74. [PMID: 27646489 DOI: 10.1080/13651501.2016.1233344] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is considered to be a common comorbid condition in subjects with obsessive-compulsive disorder (OCD), but there is limited literature on the prevalence of BD and its clinical correlates in those with a primary diagnosis of OCD. METHODS We studied the prevalence of BD in a sample of consecutively registered outpatients attending a specialty OCD clinic in India over a period of 13 months. One hundred and seventy-one patients with a primary diagnosis of OCD were assessed systematically using structured and semi-structured instruments. RESULTS The prevalence of lifetime BD in OCD was 4%. The OCD + BD group had an episodic course of OCD and higher rate of lifetime suicide attempts. CONCLUSIONS BD may not be as highly prevalent in OCD as reported in literature. Those with OCD seem to have only a marginally higher risk for developing BD than the general population. A diagnosis of BD seems to have a pathoplastic effect on the course of OCD. Patients with OCD-BD comorbidity have to be specifically assessed for suicide risk.
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Affiliation(s)
- Gayatri Saraf
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Imon Paul
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Biju Viswanath
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Janardhanan C Narayanaswamy
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Suresh Bada Math
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
| | - Y C Janardhan Reddy
- a Department of Psychiatry , National Institute of Mental Health and Neuro Sciences (NIMHANS) , Bangalore , India
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Lai J, Lu Q, Zhang P, Xu T, Xu Y, Hu S. Aripiprazole augmentation in managing comorbid obsessive-compulsive disorder and bipolar disorder: a case with suicidal attempts. Neuropsychiatr Dis Treat 2017; 13:87-90. [PMID: 28096676 PMCID: PMC5207469 DOI: 10.2147/ndt.s122316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Comorbid obsessive-compulsive disorder (OCD) and bipolar disorder (BD) have long been an intractable problem in clinical practice. The increased risk of manic/hypomanic switch hinders the use of antidepressants for managing coexisting OCD symptoms in BD patients. We herein present a case of a patient with BD-OCD comorbidity, who was successfully treated with mood stabilizers and aripiprazole augmentation. The young female patient reported recurrent depressive episodes and aggravating compulsive behaviors before hospitalization. Of note, the patient repetitively attempted suicide and reported dangerous driving because of intolerable mental sufferings. The preexisting depressive episode and OCD symptoms prompted the use of paroxetine, which consequently triggered the manic switching. Her diagnosis was revised into bipolar I disorder. Minimal response with mood stabilizers prompted the addition of aripiprazole (a daily dose of 10 mg), which helped to achieve significant remission in emotional and obsessive-compulsive symptoms. This case highlights the appealing efficacy of a small dose of aripiprazole augmentation for treating BD-OCD comorbidity. Well-designed clinical trials are warranted to verify the current findings.
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Affiliation(s)
- Jianbo Lai
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine; The Key Laboratory of Mental Disorder's Management in Zhejiang Province
| | - Qiaoqiao Lu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine
| | - Peng Zhang
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province; Department of Psychiatry, Mental Health Centre, Xiaoshan Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Tingting Xu
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province; Department of Psychiatry, Mental Health Centre, Xiaoshan Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Yi Xu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine; The Key Laboratory of Mental Disorder's Management in Zhejiang Province
| | - Shaohua Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine; The Key Laboratory of Mental Disorder's Management in Zhejiang Province
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Janardhan Reddy YC, Sundar AS, Narayanaswamy JC, Math SB. Clinical practice guidelines for Obsessive-Compulsive Disorder. Indian J Psychiatry 2017; 59:S74-S90. [PMID: 28216787 PMCID: PMC5310107 DOI: 10.4103/0019-5545.196976] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - A Shyam Sundar
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, OCD Clinic, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Nassir Ghaemi S. Bipolar I and II Disorders; A Systematic Review and Meta-Analysis on Differences in Comorbid Obsessive-Compulsive Disorder. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e3604. [PMID: 27826323 PMCID: PMC5098723 DOI: 10.17795/ijpbs-3604] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/31/2016] [Accepted: 07/23/2016] [Indexed: 02/07/2023]
Abstract
CONTEXT More than half of the bipolar disorder (BD) cases have an additional diagnosis; one of the most difficult to manage is obsessive-compulsive disorder (OCD). Although some authors recently investigated the co-occurrence of anxiety and BD, the topic remains insufficiently studied. The current study aimed to investigate differences in comorbid OCD between BD-I and BD-II. EVIDENCE ACQUISITION A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-I/BD-II and OCD. Relevant papers published until June 30, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS Fourteen articles met the inclusion criteria. The pooled prevalence of BD-I in OCD was 3.9% (95% confidence interval (CI), 2.4 to 6.4, I2 = 83%, Q = 56) while that of BD-II in OCD was 13.5% (95% CI, 9.3 to 19.3, I2 = 89%, Q = 91). The pooled prevalence of OCD in BD-I was 21.7 (95% CI, 4.8 to 60.3, I2 = 84%, Q = 95). With regard to OCD-BD predictors, mean age and rate of males did not predict the prevalence of BD-I (β = 0.0731, 95% CI, -0.1097 to 0.256, z = 0.78; β = 0.035, 95% CI, -0.2356 to 0.1656, z = 0.34) and BD-II (β = 0.0577, 95% CI, -0.1942 to 0.0788, z = 0.83; β = -0.0317, 95% CI, -0.1483 to 0.085, z = 0.53) in OCD. The mean age explained some of the observed heterogeneity (R2 = 0.13; R2 = 0.08). CONCLUSIONS This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-I/BD-II and OCD suggests that BD-OCD comorbidity is a common condition in psychiatry. However, the available evidence does not allow to assess whether BD-I or BD-II are more common in patients with OCD.
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Affiliation(s)
- Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Brendon Stubbs
- Institute of Psychiatry, Kings College London, London, UK
| | - Anna Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Carlo Marchesi
- Department of Mental Health, Local Health Service, Parma, Italy
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA
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Patra S. Treat the disease not the symptoms: Successful management of obsessive compulsive disorder in bipolar disorder with aripiprazole augmentation. Aust N Z J Psychiatry 2016; 50:809-10. [PMID: 27357710 DOI: 10.1177/0004867416656262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Suravi Patra
- Department of Psychiatry, AIIMS-Bhubaneswar, Bhubaneswar, India
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34
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Tonna M, Amerio A, Odone A, Stubbs B, Ghaemi SN. Comorbid bipolar disorder and obsessive-compulsive disorder: Which came first? Aust N Z J Psychiatry 2016; 50:695-8. [PMID: 26685183 DOI: 10.1177/0004867415621395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Anna Odone
- Unit of Public Health, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Kings College London, London, UK
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Department of Psychiatry and Pharmacology, Tufts University Medical School, Boston, MA, USA
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Abstract
Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder.
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Affiliation(s)
- Firoz Kazhungil
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India
| | - E Mohandas
- Chief Consultant Psychiatrist, Sun Medical and Research Centre, Trissur, Kerala, India
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36
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Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Comorbid bipolar disorder and obsessive-compulsive disorder in children and adolescents: Treatment implications. Aust N Z J Psychiatry 2016; 50:594-6. [PMID: 26480937 DOI: 10.1177/0004867415611235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Anna Odone
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Public Health, University of Parma, Parma, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Kings College London, London, UK
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Department of Psychiatry and Pharmacology, Tufts University Medical School, Boston, MA, USA
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Tonna M, Amerio A, Odone A, Stubbs B, Ghaemi SN. Comorbid bipolar disorder and obsessive-compulsive disorder:state of the art in pediatric patients. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 27:386-7. [PMID: 27199533 PMCID: PMC4858513 DOI: 10.11919/j.issn.1002-0829.215128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A full-text Chinese translation of this article will be available at http://dx.doi.org/10.11919/j.issn.1002-0829.215128 on April 25, 2016.
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Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Anna Odone
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Public Health, University of Parma, Parma, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Kings College London, London, UK
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA
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38
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Amerio A, Tonna M, Odone A, Ghaemi SN. Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder: An Old Debate Renewed. Psychiatry Investig 2016; 13:370-1. [PMID: 27247606 PMCID: PMC4878974 DOI: 10.4306/pi.2016.13.3.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/22/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Anna Odone
- Department of Biomedical, Biotechnological and Translational Sciences, Unit of Public Health, University of Parma, Parma, Italy
| | - S. Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
- Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA
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Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients. Asian J Psychiatr 2016; 20:12-4. [PMID: 27025465 DOI: 10.1016/j.ajp.2016.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 01/12/2023]
Abstract
Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.
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Shi S. Obsessive compulsive symptoms in bipolar disorder patients: a comorbid disorder or a subtype of bipolar disorder? SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:249-51. [PMID: 26549962 PMCID: PMC4621291 DOI: 10.11919/j.issn.1002-0829.215091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the last decade increasing attention has been focused on individuals that simultaneously
meet the criteria of two or more mental disorders. One of these comorbid conditions, comorbid bipolar
disorder and obsessive compulsive disorder, is relatively common among patients with a primary diagnosis
of bipolar disorder. But there is little research about the diagnosis and treatment of this comorbid
condition, particularly in China. The available studies are primarily cross-sectional studies with small
samples, so they are of limited use in understanding the etiology and course of this combined condition.
A review of the limited literature suggests that this is a relatively severe, refractory subtype of bipolar
disorder that only occasionally merits being considered a comorbid disorder. Larger prospective studies are
needed to clarify the etiology, prognosis, and appropriate treatment for this comorbid condition.
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Affiliation(s)
- Shenxun Shi
- Huashan Hospital, Fudan University, Shanghai, China
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41
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Tonna M, Amerio A, Odone A, Ossola P, Marchesi C, Ghaemi SN. Are obsessive-compulsive symptoms expression of vulnerability to bipolar disorder? Acta Psychiatr Scand 2015; 132:411-2. [PMID: 26366745 DOI: 10.1111/acps.12481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - A Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy. .,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - A Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - P Ossola
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - C Marchesi
- Department of Mental Health, Local Health Service, Parma, Italy.,Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.,Department of Psychiatry and Pharmacology, Tufts University Medical School, Boston, MA, USA
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Amerio A, Odone A, Tonna M, Stubbs B, Ghaemi SN. Bipolar disorder and its comorbidities between Feinstein and the Diagnostic and Statistical Manual of Mental Disorders. Aust N Z J Psychiatry 2015; 49:1073. [PMID: 26450938 DOI: 10.1177/0004867415610201] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andrea Amerio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Anna Odone
- Unit of Public Health, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Kings College London, London, UK
| | - S Nassir Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA Department of Psychiatry and Pharmacology, Tufts University Medical School, Boston, MA, USA
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43
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Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Ghaemi SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2015; 186:99-109. [PMID: 26233320 DOI: 10.1016/j.jad.2015.06.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. METHODS A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). LIMITATIONS Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. CONCLUSIONS This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups.
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Affiliation(s)
- A Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - B Stubbs
- School of Health and Social Care, University of Greenwich, London, UK.
| | - A Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - M Tonna
- Department of Mental Health, Local Health Service, Parma, Italy.
| | - C Marchesi
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy.
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA.
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Shashidhara M, Sushma BR, Viswanath B, Math SB, Janardhan Reddy YC. Comorbid obsessive compulsive disorder in patients with bipolar-I disorder. J Affect Disord 2015; 174:367-71. [PMID: 25545603 DOI: 10.1016/j.jad.2014.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited numbers of studies have examined the prevalence of OCD systematically in consecutively sampled adult bipolar disorder type I (BD-I) patients. We examined the frequency of OCD in a large number (n=396) of consecutively hospitalized patients with BD-I and identified socio-demographic and clinical correlates of BD-I with and without OCD. METHOD BD-I patients (n=396) were assessed using the Mini International Neuropsychiatric Interview for Bipolar Disorder Studies, the Structured clinical interview for (Axis II) DSM-IV, the Family interview for genetic studies, the Yale-Brown Obsessive-Compulsive Scale, the Young Mania Rating Scale, the Hamilton Rating Scale for Depression, the Global Assessment of Functioning (GAF) and the Clinical Global Impression scale. Patients with and without OCD were compared in terms of various socio-demographic and clinical variables. RESULTS Thirty (7.6%) of the 396 inpatients studied had OCD and 15 (3.8%) had subclinical OCD. BD-OCD group had significantly lower GAF scores, higher rates of unemployment, and lower incidence of psychotic symptoms. In addition, BD-OCD group had higher rates of comorbid social anxiety and anxious avoidant personality disorder (AAPD) and OCD in first-degree relatives. Those with clinical and subclinical OCD did not differ on functioning and severity measures. LIMITATIONS Retrospective design and recruitment of patients from inpatient services of a tertiary psychiatric hospital. CONCLUSION OCD is not an uncommon comorbid disorder in BD-I and appears to be associated with greater functional disability. BD-I with comorbid OCD is associated with greater family history of OCD, comorbidities of social phobia and AAPD and less of psychotic symptoms.
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Affiliation(s)
- M Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - B R Sushma
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India.
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45
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Pallanti S, Grassi G. Pharmacologic treatment of obsessive-compulsive disorder comorbidity. Expert Opin Pharmacother 2014; 15:2543-52. [DOI: 10.1517/14656566.2014.964208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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