Bidirectional comorbidity between bipolar-and obsessive-compulsive disorders: Symptoms frequency, treatment challenges and underexplored areas

Abstract

The high comorbidity of bipolar-(BD) and obsessive-compulsive disorder (OCD) is a challenge in the psychiatric field. This topic has been scarcely investigated in Latin America, and we could not find published studies conducted in Venezuela. Given the common difficulty to establish a categorical diagnosis in comorbid conditions, we assessed the frequency of current OC symptoms (OCS) in subjects with primary BD, and of BD symptoms (BDS) in subjects with primary OCD. We administered the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to 40 patients with BD, and the Young Mania Rating Scale (YMRS) and the Mood Disorder Questionnaire (MDQ) to 42 patients with OCD. We observed clinically significant OCS (Y-BOCS score ≥ 16) in 20% of BD subjects, and current hypomania or mania in 16.7% and 19% of OCD patients respectively. A significant positive correlation between age and YMRS was detected in OCD females, p = 0.04. We here confirmed the high comorbidity in the bipolar and obsessive-compulsive dimensions. Numerous studies identify the clinical burden, diagnostic difficulties and treatment intricacy of this comorbidity, which warrants for further research to assist this sensible population. We illustrate the challenges of pharmacological and psychological treatment, and the issue of family history of psychopathology, with two conspicuous clinical vignettes extracted from the studied sample.