title: Treatment of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review.
abstract: BACKGROUND
  More than 20% of patients with bipolar disorder (BD) show lifetime comorbidity for obsessive-compulsive disorder (OCD), but treatment of BD-OCD is a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined.
  
  
  METHODS
  We systematically reviewed MEDLINE, Embase, PsychINFO and the Cochrane Library and retrieved data on clinical management of comorbid BD-OCD patients. Pharmacologic, psychotherapeutic and others alternative approaches were included.
  
  
  RESULTS
  Fourteen studies were selected. In all selected studies BD-OCD patients received mood stabilizers. In the largest study, 42.1% of comorbid patients required a combination of multiple mood stabilizers and 10.5% a combination of mood stabilizers with atypical antipsychotics. Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one study. Some BD-OCD patients on mood stabilizer therapy benefitted from adjunctive psychotherapy.
  
  
  CONCLUSIONS
  Most studies are case reports or cross-sectional studies based on retrospective assessments. Enrollment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability.
  
  
  CONCLUSIONS
  Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that mood stabilization should be the primary goal in treating BD-OCD patients. Addition of SRI agents seems unnecessary in most cases, although it may be needed in a minority of BD patients with refractory OCD.
authors.affiliation: Section of Psychiatry, Department of Neuroscience, University of Parma, 43126 Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA. Electronic address: andrea.amerio@studenti.unipr.it.
authors.forename: A
authors.initials: A
authors.lastname: Amerio
authors.affiliation: School of Medicine - Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Odone
authors.affiliation: Section of Psychiatry, Department of Neuroscience, University of Parma, 43126 Parma, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Marchesi
authors.affiliation: Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Ghaemi
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Bipolar disorder; Comorbidity; Obsessive–compulsive disorder; Treatment