• obsessive compulsive disorder bipolar disorder

Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. OCD often presents itself in comorbidity with other mental disorders, like Bipolar Disorder (BD). The coexistence of BD and OCD has long intrigued experts and the exact definition of comorbidity between BD and OCD is still uncertain. It is unclear if this comorbidity indicates the simultaneous presence of two separate diseases or if it indicates a more severe subtype of either BD or OCD. The aim of this study is to understand whether, within a group of subjects with OC symptoms, the presence of a comorbidity with BD, outlines a different and specific psychopathological and therapeutic clinical picture. The study recruited a total of 277 OCD outpatients that where divided into two groups: the first one that presented also a diagnosis of BD, according to DSM criteria, and the second one without this comorbidity. All subjects were assessed with the The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to have a precise assessment of the severity of OCD symptoms. In addition, several socio-demographic, clinical and therapeutic variables have been identified. We included 60,6% of man and 39,4% of women. Considering the whole sample, we find an onset at 18.84 years old but some patients reported an onset before the age of 7. Those with a childhood onset and/or a perinatal trauma presented a more severe form of the disorder, with a greater amount of symptoms and a worse functioning. Out of 277 patients, 37.9% met the criteria for BD. This suggests that BD is a relevant diagnosis to take into account in this population. The comorbidity group had a later onset of the disorder, a gradual and protracted progression of OCD symptoms, characterized by initially moderate and sporadic obsessions or compulsions that gradually increased in frequency and intensity, a chronic course of OCD and less comorbid disorders.
Interestingly, we find a statistically significant association between the presence of OC traits and bipolar comorbidity suggesting that the presence of OC traits is associated with a higher likelihood of having bipolar comorbidity in individuals with OCD. We didn’t find significant difference in terms of symptoms severity, type of obsession and compulsions, suicidal risk or substance use between the two groups. Regarding the psychopharmacological treatment, as expected, in our sample the most commonly prescribed medications were SSRIs and Clomipramine. Considering the other medication used in this sample, there were no statistical differences between the two group except for Atypical Antipsychotics, lithium salts and Valproic acid that were more prescribed in the bipolar comorbidity. This finding aligns with the common clinical use of lithium salts, atypical antipsychotics and valproic acids as mood stabilizers in managing BD. The presence of a comorbidity with BD seems to outline a specific disorder presenting peculiar clinical characteristics and needing tailored treatment approaches. This study should be considered in light of several limitations. Further studies in wider samples and, possibly, with a longitudinal design are needed to better investigate the differences and similarities between OCD and BD-OCD to a better clinical and therapeutical management.