title: Clinical characteristics of comorbid obsessive-compulsive disorder and bipolar disorder in children and adolescents.
abstract: OBJECTIVE
  To explore bidirectional comorbidity between bipolar disorder (BPD) and obsessive-compulsive disorder (OCD) in youth and to examine the symptom profile and clinical correlates of both disorders in the context of reciprocal comorbidity and ascertainment status.
  
  
  METHODS
  Two samples of consecutively referred youth (ages 6-17 years) ascertained contemporaneously for respective studies of BPD and OCD were compared using clinical and scalar assessment and structured diagnostic interviews.
  
  
  RESULTS
  A total of 21% (17/82) of the BPD subjects and 15% (19/125) of the OCD subjects met DSM-III-R diagnostic criteria for both disorders. In the presence of BPD, youth with OCD more frequently experienced hoarding/saving obsessions and compulsions along with a clinical profile of greater comorbidity, poorer global functioning, and higher rate of hospitalization that is characteristic of BPD. Multiple anxiety disorders (> or = 3), especially generalized anxiety disorder and social phobia, were present at a higher frequency when OCD and BPD were comorbid than otherwise. In subjects with comorbid OCD and BPD, the primary disorder of ascertainment was associated with an earlier onset and more severe impairment.
  
  
  CONCLUSIONS
  An unexpectedly high rate of comorbidity between BPD and OCD was observed in youth irrespective of primary ascertainment diagnosis. In youth with comorbid OCD and BPD, the clinical characteristics of each disorder run true and are analogues to their clinical presentation in youth without reciprocal comorbidity, with the exception of increased risk for obsessions and compulsions of hoarding/saving and comorbidity with other anxiety disorders.
authors.affiliation: Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. joshi.gagan@mgh.harvard.edu
authors.forename: Gagan
authors.initials: G
authors.lastname: Joshi
authors.forename: Janet
authors.initials: J
authors.lastname: Wozniak
authors.forename: Carter
authors.initials: C
authors.lastname: Petty
authors.forename: Fe
authors.initials: F
authors.lastname: Vivas
authors.forename: Dayna
authors.initials: D
authors.lastname: Yorks
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
authors.forename: Daniel
authors.initials: D
authors.lastname: Geller
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D001900:Boston / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D003192:Compulsive Behavior / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009770:Obsessive Behavior / Q000453:epidemiology / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D010698:Phobic Disorders / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1046-55
references.pmid: 9256584
references.citation: J Affect Disord. 1997 Oct;46(1):15-23
references.pmid: 9387083
references.citation: J Affect Disord. 1997 Jul;44(2-3):177-88
references.pmid: 9241578
references.citation: J Affect Disord. 1995 May 17;34(2):117-20
references.pmid: 7665803
references.citation: J Clin Psychiatry. 2005 Jan;66(1):49-51
references.pmid: 15669888
references.citation: Arch Gen Psychiatry. 1976 Jun;33(6):766-71
references.pmid: 938196
references.citation: J Affect Disord. 2002 Feb;68(1):1-23
references.pmid: 11869778
references.citation: J Child Psychol Psychiatry. 1994 Sep;35(6):1141-57
references.pmid: 7995848
references.citation: Eur Arch Psychiatry Clin Neurosci. 2006 Jun;256(4):240-5
references.pmid: 16683062
references.citation: Bipolar Disord. 2004 Aug;6(4):305-13
references.pmid: 15225148
references.citation: Br J Psychiatry. 1998 Dec;173:514-8
references.pmid: 9926081
references.citation: J Child Adolesc Psychopharmacol. 2002 Summer;12(2):101-11
references.pmid: 12188979
references.citation: Am J Psychiatry. 2000 Oct;157(10):1679-81
references.pmid: 11007724
references.citation: J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):107-125
references.pmid: 17195735
references.citation: Psychol Med. 1997 Sep;27(5):1101-19
references.pmid: 9300515
references.citation: Psychol Med. 1999 May;29(3):555-67
references.pmid: 10405077
references.citation: J Child Psychol Psychiatry. 1999 Jan;40(1):57-87
references.pmid: 10102726
references.citation: J Abnorm Psychol. 1985 May;94(2):115-27
references.pmid: 3998280
references.citation: Psychiatry. 1991 May;54(2):116-32
references.pmid: 1852846
references.citation: Biol Psychiatry. 2007 Jun 15;61(12):1388-94
references.pmid: 17241617
references.citation: J Affect Disord. 2005 Sep;88(1):19-26
references.pmid: 16043229
references.citation: Arch Gen Psychiatry. 1989 Nov;46(11):1006-11
references.pmid: 2684084
references.citation: J Child Adolesc Psychopharmacol. 2007 Aug;17(4):475-86
references.pmid: 17822342
references.citation: J Affect Disord. 2004 Mar;78(3):175-83
references.pmid: 15013241
references.citation: Psychiatry Res. 1995 Nov 29;59(1-2):57-64
references.pmid: 8771221
references.citation: J Am Acad Child Adolesc Psychiatry. 1999 Jan;38(1):6-7
references.pmid: 9893408
references.citation: Psychol Med. 2010 Jul;40(7):1079-88
references.pmid: 19891803
references.citation: J Clin Psychiatry. 2002 May;63(5):414-9
references.pmid: 12019666
references.citation: J Clin Psychiatry. 2002 Dec;63(12):1129-34
references.pmid: 12523872
references.citation: Can J Psychiatry. 2001 Nov;46(9):797-802
references.pmid: 11761630
references.citation: Am J Psychiatry. 2007 Mar;164(3):380-4
references.pmid: 17329459
references.citation: J Affect Disord. 2003 Jun;75(1):1-10
references.pmid: 12781344
references.citation: J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1486-93
references.pmid: 14627884
references.citation: J Am Acad Child Adolesc Psychiatry. 1988 Nov;27(6):764-71
references.pmid: 3264280
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Dec;35(12):1637-46
references.pmid: 8973071
references.citation: Am J Psychiatry. 2001 Mar;158(3):420-6
references.pmid: 11229983
references.citation: Compr Psychiatry. 2007 May-Jun;48(3):245-51
references.pmid: 17445518
references.citation: J Am Acad Child Adolesc Psychiatry. 1995 Nov;34(11):1424-31
references.pmid: 8543509
references.citation: Am J Psychiatry. 1999 Mar;156(3):474-6
references.pmid: 10080568