Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.
Issler CK, Monkul ES, Amaral JAMS, Tamada RS, Shavitt RG, Miguel EC, Lafer B. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.


OBJECTIVE
Although bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) is highly prevalent, few controlled studies have assessed this comorbidity. The objective of this study was to investigate the clinical characteristics and expression of comorbid disorders in female BD patients with OCD.


METHODS
We assessed clinically stable female outpatients with BD: 15 with comorbid OCD (BD+OCD group) and 15 without (BD/no-OCD group). All were submitted to the Structured Clinical Interview for DSM-IV, with additional modules for the diagnosis of kleptomania, trichotillomania, pathological gambling, onychophagia and skin picking.


RESULTS
The BD+OCD patients presented more chronic episodes, residual symptoms and previous depressive episodes than the BD/no-OCD patients. Of the BD+OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the BD/no-OCD patients. The following were more prevalent in the BD+OCD patients than the BD/no-OCD patients: any anxiety disorder other than OCD; impulse control disorders; eating disorders; and tic disorders.


CONCLUSIONS
Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.
1Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Cilly Klüger
CK
Issler
1Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Emel Serap
ES
Monkul
1Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
José Antonio de Mello Siqueira
JA
Amaral
1Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Renata Sayuri
RS
Tamada
2Obsessive-Compulsive Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Roseli Gedanke
RG
Shavitt
2Obsessive-Compulsive Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Eurípedes C
EC
Miguel
1Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Beny
B
Lafer