Obsessive–compulsive disorder with and without bipolar disorder

• Published in: Psychiatry and clinical neurosciences Vol. 65; no. 5; pp. 423 - 433
• Main Authors: Mahasuar, Rajnarayan, Janardhan Reddy, Y. C., Math, Suresh Bada
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.08.2011; Wiley-Blackwell
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - complications; Bipolar Disorder - diagnosis; Bipolar Disorder - psychology; Bipolar disorders; comorbidity; course; Disease Progression; Female; Hospitalization - statistics & numerical data; Humans; Intuition; Male; Medical sciences; Middle Aged; Mood disorders; Morbidity; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - complications; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - psychology; Obsessive-compulsive disorders; Psychiatric Status Rating Scales - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Suicidal Ideation; Mood disorder; Obsessive compulsive disorder; Concomitant disease; comorbidity; obsessive-compulsive disorder; Anxiety disorder; Bipolar disorder; course; Comparative study
• ISSN: 1323-1316; 1440-1819
• DOI: 10.1111/j.1440-1819.2011.02247.x

Aim:  Bipolar disorder (BD) is often comorbid with obsessive–compulsive disorder (OCD). In this study, we compared clinical profile and course of subjects with a primary diagnosis of OCD with and without BD. Methods:  We compared 34 subjects with primary diagnosis of OCD with BD and 57 subjects with a diagnosis of OCD without BD. Structured interview schedules, clinical rating scales, and information from clinical charts were utilized to assess patients. Results:  OCD with BD was characterized by: (i) an episodic course; (ii) a higher number of depressive episodes, greater suicidality and a higher rate of hospitalization; (iii) fewer pathological doubts and more miscellaneous compulsions; and (iv) poorer insight into obsessive–compulsive symptoms. Conclusions:  Episodic course appears to be typical of OCD with BD. Bipolarity has a pathoplastic effect on OCD and it is possible that some forms of OCD and BD are pathophysiologically related. Bipolar OCD is associated with a higher rate of depressive episodes, higher suicidality and more frequent hospitalizations, suggesting greater morbidity. Long‐term prospective follow‐up studies and studies addressing pathophysiology and genetic basis are needed to understand the complexity of such comorbidity.