Obsessive Compulsive Disorder and Bipolar Disorder Comorbidity: A Comparative Study
,
Abstract
Objective: One of the difficult comorbidity of Obsessive-Compulsive disorder (OCD) to manage is bipolar disorder (BD). Results of previous studies on OCD-BD comorbidity may have been affected by different clinical definitions of OCD-BD, small or different sample sizes, different thresholds for including BD patients and different accuracies in OCD diagnosing. We tried to reduce limitations of previous studies and hypothesized that the OCD-BD group is a unique category and can be associated with greater levels of severity, episodic course of illness, more hostility and suicidal behaviors and different dimensions of OC symptoms.
Method: We compared 44 OCD-BD patients with 94 OCD patients who had completed at least a 24-month follow-up period. Clinical interviews and rating scales, and obtaining information from clinical charts were used to assess the patients. Life chartings of OCD and BD course were made for each patient and were categorized into four groups based on the clinical course of OCD.
Results: OCD-BD was characterized by a more continuous course, higher dysfunction, suicide and hostility scores. OC aggressive symptoms, having first-degree relatives with OCD and comorbidity of any anxiety disorders were associated with a reduction in odds of belonging to the OCD-BD group.
Conclusion: OCD-BD can be considered a unique category with greater morbidity and a more episodic course of OCD. Further research is recommended for exploring potential biological, social and psychological factors along with OCD-BD comorbidity.
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2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
3. Angst J, Gamma A, Endrass J, Hantouche E, Goodwin R, Ajdacic V, et al. Obsessive-compulsive syndromes and disorders. Eur Arch Psychiatry Clin Neurosci. 2005;255(1):65-71.
4. Fornaro M, Gabrielli F, Albano C, Fornaro S, Rizzato S, Mattei C, et al. Obsessive-compulsive disorder and related disorders: a comprehensive survey. Ann Gen Psychiatry. 2009;8:13.
5. Adam Y, Meinlschmidt G, Gloster AT, Lieb R. Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):339-49.
6. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Treatment of comorbid bipolar disorder and anxiety disorders: A great challenge to modern psychiatry. Aust N Z J Psychiatry. 2016;50(7):699-700.
7. Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med. 1998;4(11):1241-3.
8. 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.
9. Amerio A, Odone A, Marchesi C, Ghaemi SN. Treatment of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. J Affect Disord. 2014;166:258-63.
10. Torres AR, Fontenelle LF, Shavitt RG, Ferrão YA, do Rosário MC, Storch EA, et al. Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample. J Affect Disord. 2016;190:508-16.
11. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients. Asian J Psychiatr. 2016;20:12-4.
12. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients. Shanghai Arch Psychiatry. 2015;27(5):307-10.
13. 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(6):594-6.
14. Masi G, Berloffa S, Mucci M, Pfanner C, D'Acunto G, Lenzi F, et al. A NATURALISTIC EXPLORATORY STUDY OF OBSESSIVE-COMPULSIVE BIPOLAR COMORBIDITY IN YOUTH. J Affect Disord. 2018;231:21-6.
15. Mucci F, Toni C, Favaretto E, Vannucchi G, Marazziti D, Perugi G. Obsessive-compulsive Disorder with Comorbid Bipolar Disorders: Clinical Features and Treatment Implications. Curr Med Chem. 2018;25(41):5722-30.
16. Hasler G, LaSalle-Ricci VH, Ronquillo JG, Crawley SA, Cochran LW, Kazuba D, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005;135(2):121-32.
17. 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. Iran J Psychiatry Behav Sci. 2016;10(3):e3604.
18. Jeon S, Baek JH, Yang SY, Choi Y, Ahn SW, Ha K, et al. 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;225:227-33.
19. Association AP. Diagnostic and statistical manual of mental disorders. BMC Med. 2013;17:133-7.
20. Esfahani SR, Motaghipour Y, Kamkari K, Zahiredin A, Janbozorgi M. Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). IJPCP. 2012;17(4):297-303.
21. Mataix-Cols D, Rosario-Campos MC, Leckman JF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry. 2005;162(2):228-38.
22. Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28-37.
23. Aas IH. Guidelines for rating Global Assessment of Functioning (GAF). Ann Gen Psychiatry. 2011;10:2.
24. Zarrabi H, Khalkhali M, Hamidi A, Ahmadi R, Zavarmousavi M. Clinical features, course and treatment of methamphetamine-induced psychosis in psychiatric inpatients. BMC Psychiatry. 2016;16:44.
25. Shabani A, Taheri A, Azadforouz S, Abbasi CN, Mousavi Z, Zangeneh K, et al. Bipolar Disorder Patients Follow-up (BDPF): methods and materials. J Res Med Sci. 2010;15(4):229-34.
26. Reddy YC, D'Souza SM, Shetti C, Kandavel T, Deshpande S, Badamath S, et al. An 11- to 13-year follow-up of 75 subjects with obsessive-compulsive disorder. J Clin Psychiatry. 2005;66(6):744-9.
27. Reddy YC, Srinath S, Prakash HM, Girimaji SC, Sheshadri SP, Khanna S, et al. A follow-up study of juvenile obsessive-compulsive disorder from India. Acta Psychiatr Scand. 2003;107(6):457-64.
28. Mahasuar R, Janardhan Reddy Y, Math SB. Obsessive–compulsive disorder with and without bipolar disorder. Psychiatry Clin Neurosci. 2011;65(5):423-33.
29. Saraf G, Paul I, Viswanath B, Narayanaswamy JC, Math SB, Reddy YC. Bipolar disorder comorbidity in patients with a primary diagnosis of OCD. Int J Psychiatry Clin Pract. 2017;21(1):70-4.
30. Koyuncu A, Ertekin E, Binbay Z, Ozyıldırım I, Yüksel C, Tükel R. The clinical impact of mood disorder comorbidity on social anxiety disorder. Compr Psychiatry. 2014;55(2):363-9.
31. Zutshi A, Kamath P, Reddy YC. Bipolar and nonbipolar obsessive-compulsive disorder: a clinical exploration. Compr Psychiatry. 2007;48(3):245-51.
32. Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, et al. The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J Affect Disord. 1997;46(1):15-23.
33. Masi G, Perugi G, Toni C, Millepiedi S, Mucci M, Bertini N, et al. Obsessive-compulsive bipolar comorbidity: focus on children and adolescents. J Affect Disord. 2004;78(3):175-83.
34. Hantouche EG, Angst J, Demonfaucon C, Perugi G, Lancrenon S, Akiskal HS. Cyclothymic OCD: a distinct form? J Affect Disord. 2003;75(1):1-10.
35. Joshi G, Wozniak J, Petty C, Vivas F, Yorks D, Biederman J, et al. Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents. Bipolar Disord. 2010;12(2):185-95.
36. Ozdemiroglu F, Sevincok L, Sen G, Mersin S, Kocabas O, Karakus K, et al. Comorbid obsessive-compulsive disorder with bipolar disorder: A distinct form? Psychiatry Res. 2015;230(3):800-5.
37. Timpano KR, Rubenstein LM, Murphy DL. Phenomenological features and clinical impact of affective disorders in OCD: a focus on the bipolar disorder and OCD connection. Depress Anxiety. 2012;29(3):226-33.
38. Cooper M. Obsessive-compulsive disorder: effects on family members. Am J Orthopsychiatry. 1996;66(2):296-304.
39. Albert U, Baffa A, Maina G. Family accommodation in adult obsessive-compulsive disorder: clinical perspectives. Psychol Res Behav Manag. 2017;10:293-304.
40. Jayakumar C, Jagadheesan K, Verma AN. Caregiver'S burden : a comparison between obsessive compulsive disorder and schizophrenia. Indian J Psychiatry. 2002;44(4):337-42.
41. Fontenelle LF, Oostermeijer S, Harrison BJ, Pantelis C, Yücel M. Obsessive-compulsive disorder, impulse control disorders and drug addiction: common features and potential treatments. Drugs. 2011;71(7):827-40.
42. Tellawi G, Williams MT, Chasson GS. Interpersonal hostility and suspicious thinking in obsessive-compulsive disorder. Psychiatry Res. 2016;243:295-302.
43. Steketee G. Social support and treatment outcome of obsessive compulsive disorder at 9-month follow-up. Behav Cogn Psychother. 1993;21(2):81-95.
44. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53-63.
2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
3. Angst J, Gamma A, Endrass J, Hantouche E, Goodwin R, Ajdacic V, et al. Obsessive-compulsive syndromes and disorders. Eur Arch Psychiatry Clin Neurosci. 2005;255(1):65-71.
4. Fornaro M, Gabrielli F, Albano C, Fornaro S, Rizzato S, Mattei C, et al. Obsessive-compulsive disorder and related disorders: a comprehensive survey. Ann Gen Psychiatry. 2009;8:13.
5. Adam Y, Meinlschmidt G, Gloster AT, Lieb R. Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):339-49.
6. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Treatment of comorbid bipolar disorder and anxiety disorders: A great challenge to modern psychiatry. Aust N Z J Psychiatry. 2016;50(7):699-700.
7. Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med. 1998;4(11):1241-3.
8. 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.
9. Amerio A, Odone A, Marchesi C, Ghaemi SN. Treatment of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. J Affect Disord. 2014;166:258-63.
10. Torres AR, Fontenelle LF, Shavitt RG, Ferrão YA, do Rosário MC, Storch EA, et al. Comorbidity variation in patients with obsessive-compulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample. J Affect Disord. 2016;190:508-16.
11. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients. Asian J Psychiatr. 2016;20:12-4.
12. Amerio A, Tonna M, Odone A, Stubbs B, Ghaemi SN. Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients. Shanghai Arch Psychiatry. 2015;27(5):307-10.
13. 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(6):594-6.
14. Masi G, Berloffa S, Mucci M, Pfanner C, D'Acunto G, Lenzi F, et al. A NATURALISTIC EXPLORATORY STUDY OF OBSESSIVE-COMPULSIVE BIPOLAR COMORBIDITY IN YOUTH. J Affect Disord. 2018;231:21-6.
15. Mucci F, Toni C, Favaretto E, Vannucchi G, Marazziti D, Perugi G. Obsessive-compulsive Disorder with Comorbid Bipolar Disorders: Clinical Features and Treatment Implications. Curr Med Chem. 2018;25(41):5722-30.
16. Hasler G, LaSalle-Ricci VH, Ronquillo JG, Crawley SA, Cochran LW, Kazuba D, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005;135(2):121-32.
17. 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. Iran J Psychiatry Behav Sci. 2016;10(3):e3604.
18. Jeon S, Baek JH, Yang SY, Choi Y, Ahn SW, Ha K, et al. 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;225:227-33.
19. Association AP. Diagnostic and statistical manual of mental disorders. BMC Med. 2013;17:133-7.
20. Esfahani SR, Motaghipour Y, Kamkari K, Zahiredin A, Janbozorgi M. Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). IJPCP. 2012;17(4):297-303.
21. Mataix-Cols D, Rosario-Campos MC, Leckman JF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry. 2005;162(2):228-38.
22. Busner J, Targum SD. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28-37.
23. Aas IH. Guidelines for rating Global Assessment of Functioning (GAF). Ann Gen Psychiatry. 2011;10:2.
24. Zarrabi H, Khalkhali M, Hamidi A, Ahmadi R, Zavarmousavi M. Clinical features, course and treatment of methamphetamine-induced psychosis in psychiatric inpatients. BMC Psychiatry. 2016;16:44.
25. Shabani A, Taheri A, Azadforouz S, Abbasi CN, Mousavi Z, Zangeneh K, et al. Bipolar Disorder Patients Follow-up (BDPF): methods and materials. J Res Med Sci. 2010;15(4):229-34.
26. Reddy YC, D'Souza SM, Shetti C, Kandavel T, Deshpande S, Badamath S, et al. An 11- to 13-year follow-up of 75 subjects with obsessive-compulsive disorder. J Clin Psychiatry. 2005;66(6):744-9.
27. Reddy YC, Srinath S, Prakash HM, Girimaji SC, Sheshadri SP, Khanna S, et al. A follow-up study of juvenile obsessive-compulsive disorder from India. Acta Psychiatr Scand. 2003;107(6):457-64.
28. Mahasuar R, Janardhan Reddy Y, Math SB. Obsessive–compulsive disorder with and without bipolar disorder. Psychiatry Clin Neurosci. 2011;65(5):423-33.
29. Saraf G, Paul I, Viswanath B, Narayanaswamy JC, Math SB, Reddy YC. Bipolar disorder comorbidity in patients with a primary diagnosis of OCD. Int J Psychiatry Clin Pract. 2017;21(1):70-4.
30. Koyuncu A, Ertekin E, Binbay Z, Ozyıldırım I, Yüksel C, Tükel R. The clinical impact of mood disorder comorbidity on social anxiety disorder. Compr Psychiatry. 2014;55(2):363-9.
31. Zutshi A, Kamath P, Reddy YC. Bipolar and nonbipolar obsessive-compulsive disorder: a clinical exploration. Compr Psychiatry. 2007;48(3):245-51.
32. Perugi G, Akiskal HS, Pfanner C, Presta S, Gemignani A, Milanfranchi A, et al. The clinical impact of bipolar and unipolar affective comorbidity on obsessive-compulsive disorder. J Affect Disord. 1997;46(1):15-23.
33. Masi G, Perugi G, Toni C, Millepiedi S, Mucci M, Bertini N, et al. Obsessive-compulsive bipolar comorbidity: focus on children and adolescents. J Affect Disord. 2004;78(3):175-83.
34. Hantouche EG, Angst J, Demonfaucon C, Perugi G, Lancrenon S, Akiskal HS. Cyclothymic OCD: a distinct form? J Affect Disord. 2003;75(1):1-10.
35. Joshi G, Wozniak J, Petty C, Vivas F, Yorks D, Biederman J, et al. Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents. Bipolar Disord. 2010;12(2):185-95.
36. Ozdemiroglu F, Sevincok L, Sen G, Mersin S, Kocabas O, Karakus K, et al. Comorbid obsessive-compulsive disorder with bipolar disorder: A distinct form? Psychiatry Res. 2015;230(3):800-5.
37. Timpano KR, Rubenstein LM, Murphy DL. Phenomenological features and clinical impact of affective disorders in OCD: a focus on the bipolar disorder and OCD connection. Depress Anxiety. 2012;29(3):226-33.
38. Cooper M. Obsessive-compulsive disorder: effects on family members. Am J Orthopsychiatry. 1996;66(2):296-304.
39. Albert U, Baffa A, Maina G. Family accommodation in adult obsessive-compulsive disorder: clinical perspectives. Psychol Res Behav Manag. 2017;10:293-304.
40. Jayakumar C, Jagadheesan K, Verma AN. Caregiver'S burden : a comparison between obsessive compulsive disorder and schizophrenia. Indian J Psychiatry. 2002;44(4):337-42.
41. Fontenelle LF, Oostermeijer S, Harrison BJ, Pantelis C, Yücel M. Obsessive-compulsive disorder, impulse control disorders and drug addiction: common features and potential treatments. Drugs. 2011;71(7):827-40.
42. Tellawi G, Williams MT, Chasson GS. Interpersonal hostility and suspicious thinking in obsessive-compulsive disorder. Psychiatry Res. 2016;243:295-302.
43. Steketee G. Social support and treatment outcome of obsessive compulsive disorder at 9-month follow-up. Behav Cogn Psychother. 1993;21(2):81-95.
44. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53-63.
| Files | ||
| Issue | Vol 17 No 2 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i2.8902 | |
| Keywords | ||
| Bipolar Disorder Comorbidity Obsessive-Compulsive Disorder | ||
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How to Cite
1.
Khalkhali M, Vaghari S, Zare R, Kafi Masouleh SM. Obsessive Compulsive Disorder and Bipolar Disorder Comorbidity: A Comparative Study. Iran J Psychiatry. 2022;17(2):127-135.
