Around 20% of children and adolescents with an initial diagnosis of bipolar disorder also meet criteria for obsessive??”compulsive disorder (OCD), while a similar number of obsessive??”compulsive disorder patients have underlying bipolar disorder, study results show.

The findings highlight the importance of evaluating patients with bipolar disorder and OCD for reciprocal comorbidity, say study author Gagan Joshi (Massachusetts General Hospital, Boston, USA) and colleagues.

“Considering the extreme severity of juvenile mania, its emergence in children with OCD seriously complicates their treatment, as anti-OCD agents have the risk of exacerbating mood symptoms, and precipitating mania and antimanic agents show marginal efficacy in treating OCD symptoms,” they comment in the journal Bipolar Disorders.

Although clinical studies have begun to address the issue of bipolar disorder??”OCD comorbidity in adult patients, there are little data in pediatric populations.

To investigate the researchers recruited 82 youths with bipolar disorder from a pediatric bipolar family genetic study and 125 youths with OCD from a pediatric OCD family genetic study. All participants were aged between 6 and 17 years.

Detailed clinical interviews revealed that 17 (21%) patients in the bipolar disorder groups and 19 (15%) patients in the OCD group met DSM-III-R diagnostic criteria for both disorders. This shows bidirectional and symmetrical overlap between bipolar disorder and OCD, which is unlikely to be the result of referral or ascertainment bias, say the researchers.

Among patients with bipolar disorder, the number and frequency of mania symptoms were similar in those with and without OCD. Likewise, the number and frequency of obsessive and compulsive symptoms did not differ between OCD with and without BPD comorbidity.

Thus, the clinical characteristics of each disorder run true and are analogs to their clinical presentation in youth without reciprocal comorbidity, Joshi et al comment.

Notably though, there was an increased prevalence of multiple anxiety disorders and selective increase in frequency of obsession and compulsion of hoarding/saving when bipolar disorder and OCD were comorbid than as single disorders.

Joshi et al comment: “Whether hoarding/saving could emerge as a symptom marker for BPD comorbidity in youth with OCD requires further investigation in larger populations.”

They add: “Future studies examining the patterns of familial aggregation of OCD and BPD, along with longitudinal studies addressing the impact of comorbidity on the clinical presentation, course, and response to treatment, would assist in further defining this comorbid condition.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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