title: Impact of depressive and anxiety disorder comorbidity on the clinical expression of obsessive-compulsive disorder.
abstract: BACKGROUND
  The identification of distinct subtypes based on comorbidity offers potential utility in understanding variations in the clinical expression of obsessive-compulsive disorder (OCD). Hence, we examined the hypothesis whether patients with OCD with major depressive disorder (MDD) or anxiety disorder comorbidity would differ from those without in terms of phenomenology.
  
  
  METHODS
  A total of 545 consecutive patients who consulted a specialty OCD clinic during the period 2004 to 2009 at a psychiatric hospital in India formed the sample. They were evaluated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Mini International Neuropsychiatric Interview, and the Clinical Global Impression scale.
  
  
  RESULTS
  Among 545 patients, 165 (30%) had current MDD, and 114 (21%) had current anxiety disorder comorbidity. Patients with OCD with MDD were mostly women who had a greater severity of OCD symptoms, more of obsessions (especially religious), greater occurrence of miscellaneous compulsions (need to confess or need to touch), higher suicidal risk, and past suicidal attempts. Patients with OCD with anxiety disorder had an earlier onset of illness that was associated with prior life events, less of compulsions, more of aggressive and hoarding obsessions, pathologic doubts, checking, and cognitive compulsions.
  
  
  CONCLUSIONS
  Obsessive-compulsive disorder, when comorbid with MDD, is more severe and is associated with higher suicidal risk. On the other hand, anxiety disorder comorbidity seems to influence not so much the morbidity but the phenotypic expression of OCD.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India. bijuv1@gmail.com
authors.forename: Biju
authors.initials: B
authors.lastname: Viswanath
authors.forename: Janardhanan C
authors.initials: JC
authors.lastname: Narayanaswamy
authors.forename: Ravi Philip
authors.initials: RP
authors.lastname: Rajkumar
authors.forename: Anish V
authors.initials: AV
authors.lastname: Cherian
authors.forename: Thennarasu
authors.initials: T
authors.lastname: Kandavel
authors.forename: Suresh Bada
authors.initials: SB
authors.lastname: Math
authors.forename: Y C Janardhan
authors.initials: YC
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001008:Anxiety Disorders / Q000150:complications* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012306:Risk; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires