OCD increases illness burden in bipolar disorder
MedWire News: Patients with bipolar disorder and comorbid obsessive-compulsive disorder (OCD) are more likely to have a history of suicide attempts, rapid cycling, and alcohol dependence compared with their peers without anxiety comorbidities, study results show.
"The data in this report support the notion that comorbid OCD is fairly common, is associated with disease severity, and has important consequences regarding symptom- and patient-rated outcomes," comment Flávio Kapczinski (Hospital de Clínicas de Porto Alegre, Brazil) and colleagues.
The prominence of anxiety in general and OCD in particular among patients with bipolar disorder has long been acknowledged. Recent studies have tried to investigate the illness burden of OCD, but comparisons have usually been made between those with and without OCD comorbidity.
"This is little informative because those patients with any comorbidity tend to differ in a number of measures from those with 'pure' bipolar disorder," the researchers explain in the journal Comprehensive Psychiatry.
To address this, they performed a cross-sectional study of lifetime comorbidities in 259 patients with bipolar disorder, using anxiety comorbidities as a "more rigorous control group with the aim of uncovering more specific correlates of OCD comorbidity in bipolar disorder."
Kapczinski et al report that lifetime prevalence of any anxiety disorder was 55.6%, and of OCD, 12.4%. Current prevalence of OCD was 8.5%; although no cases were detected during mania, it was diagnosed in 8.4% of those in a euthymic phase, 13.9% of those depressed, and 13.0% of those with mixed episodes.
The researchers note that this fits with recent studies showing that obsessions or compulsions may remit during mania to reappear in depression.
Compared with patients with no anxiety comorbidity, those with lifetime OCD were more likely to be women (61.8% vs 84.4%), to have a longer period of untreated illness (8 vs 13 years), have a lifetime history of suicide attempts (35% vs 70%), rapid cycling (14% vs 39%), and alcohol dependence (10% vs 31%).
Patients with OCD also had higher depression and anxiety symptom scores than those without anxiety comorbidity, but fewer manic symptoms.
Meanwhile, when compared with patients with other lifetime anxiety disorders, those with OCD comorbidity had a lower quality of life on the social domain.
Kapczinski et al comment: "Patients with OCD are troubled by thoughts and behaviors, which seem frequently repugnant and further restrict their social functioning.
"They also often incite friends or family members to engage in their illness-related behaviors, which may result in conflict."
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By Andrew Czyzewski