Clinical management of obsessive-compulsive-bipolar comorbidity: a case series.
OBJECTIVE
To assess the clinical characteristics and the optimal treatment of obsessive compulsive symptoms in patients with familial background, current or past symptoms consistent with a bipolar spectrum diagnosis.


METHODS
Longitudinal clinical observation of seven cases with obsessive-compulsive-bipolar comorbidity.


RESULTS
In the cases presented that met the DSM-IV-TR criteria for obsessive compulsive disorder (OCD), the concurrent symptoms and the clinical course pointed to a different principal diagnosis and suggested therapeutic strategies different from those currently recommended in OCD. Clear-cut onset of symptoms, high prevalence of mood disorders in relatives, revaluation of their history, switch into mania induced by antidepressants, and clinical follow-up suggested a hierarchical priority of bipolar diagnosis.


CONCLUSIONS
The presence of the aforementioned atypical symptoms should alert the physician about the possibility of bipolar comorbidity in OCD patients. If the suspicion is confirmed, bipolar diagnosis should have priority, at least from a therapeutic point of view. The first choice in treatment should be with mood stabilizers or second generation antipsychotics. Mood stabilization should be achieved as a first objective.
Raja
Michele
M
Servizio Psichiatrico di Diagnosi e Cura, Ospedale Santo Spirito, Rome, Italy. michele.raja@libero.it
Azzoni
Antonella
A
D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011619:Psychotropic Drugs / Q000627:therapeutic use*
D011619:Psychotropic Drugs