title: Clinical expression of obsessive-compulsive disorder in women with bipolar disorder.
abstract: OBJECTIVE
  To study clinical and psychopathological features of obsessive-compulsive disorder (OCD) in women with bipolar disorder (BD).
  
  
  METHODS
  Fifteen outpatients with concurrent bipolar disorder I (80.0%) or II (20.0%) and obsessive-compulsive disorder were studied. Most of them (80.0%) sought treatment for bipolar disorder. They were ascertained by means of the Structured Clinical Interview for DSM-IV (SCID/P), semi-structured interviews to investigate obsessions, compulsions and sensory phenomena that may precede compulsions and an additional module for the diagnosis of chronic motor and vocal tics. Severity of symptoms was assessed by the Yale-Brown Obsessive-Compulsive Rating Scale, Hamilton Depression Rating Scale and Young Mania Rating Scale.
  
  
  RESULTS
  Obsessive-compulsive disorder presented early onset (before the age of 10) in 9 (60%) cases, preceded bipolar disorder in 10 (66.7%) and displayed chronic waxing and waning course in 13 (86.7%) of them. There was wide overlap between types of obsessive-compulsive symptoms and all patients experienced sensory phenomena preceding the compulsions. There was no clear-cut impact of depressive and manic episodes on the intensity of obsessive-compulsive symptoms, which increased in depression and decreased in mania in 40.0% of the cases, had the opposite pattern in 26.7% of the patients and fluctuated inconsistently in the rest of them. Tics disorders were diagnosed in 5 (33.3%) patients.
  
  
  CONCLUSIONS
  Our results suggest that in women with comorbid bipolar disorder and obsessive-compulsive disorder the latter presents features that may be typical of the association of the two disorders, such as early onset and sensory phenomena preceding compulsions. A prospective controlled study is necessary to confirm these observations, due to some limitations of our study: small exclusively female sample, heterogeneity concerning the type of bipolar disorder and the disorder that determined sought of treatment and retrospective non-controlled design.
authors.affiliation: Psychiatric Institute, Clinical Hospital, Medical School, Universidade de São Paulo, São Paulo, Brazil. cillykissler@yahoo.com.br
authors.forename: Cilly Klüger
authors.initials: CK
authors.lastname: Issler
authors.forename: José Antonio de Mello Siqueira
authors.initials: JA
authors.lastname: Amaral
authors.forename: Renata Sayuri
authors.initials: RS
authors.lastname: Tamada
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Schwartzmann
authors.forename: Roseli Gedanke
authors.initials: RG
authors.lastname: Shavitt
authors.forename: Eurípedes Constantino
authors.initials: EC
authors.lastname: Miguel
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors