Comorbid OCD not uncommon in bipolar disorder

By Shreeya Nanda, Senior medwireNews Reporter

Co-occurrence of obsessive compulsive disorder (OCD) in patients with bipolar disorder type I (BD-I) is not uncommon and is associated with increased functional disability, research findings indicate.

The study included 396 patients with BD-I consecutively admitted to the inpatient services of an Indian mental health institute over a 1-year period. Of these, 30 (7.6%) had comorbid OCD, scoring higher than 15 on the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) and fulfilling the DSM-IV criteria for OCD. A further 15 (3.8%) patients had subclinical OCD, with a Y-BOCS score below 7.

There was no significant difference between patients with OCD and those with subclinical OCD in terms of functioning, severity of manic and depressive symptoms or in the number of hospitalisations.

YC Janardhan Reddy (National Institute of Mental Health and Neuro Sciences, Bangalore, India) and colleagues also compared various sociodemographical and clinical variables in BD-I patients with and without OCD.

BD-I patients with OCD had lower scores on the Global Assessment of Functioning (GAF) scale and significantly higher rates of unemployment than those without OCD, “indicating a higher disability”, the researchers report.

Presence of comorbid OCD was also associated with higher prevalence of social phobia and anxious avoidant personality disorder. And a significantly greater proportion of BD-I individuals with OCD had first-degree relatives with OCD compared with those with BD-I alone.

Interestingly, the incidence of psychotic symptoms was lower in the BD-I–OCD group than in the BD-I only group, leading Reddy et al to speculate that “OCD could be a protective factor against psychosis in these patients”, consistent with previous results in patients with schizophrenia and comorbid OCD.

On regression analysis, functioning scores, occupational status, psychotic symptoms and anxious avoidant personality disorder remained significantly associated with OCD, whereas comorbid social phobia and family history of OCD did not

“This study stresses the need for detailed evaluation for OCD in patients with BD-I”, the team writes in the Journal of Affective Disorders.

They conclude: “Unrecognized OCD in BD-I can lead to more functional disability. Future research should focus on examining the impact of comorbid OCD on treatment response and long-term course of BD-I.”

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