Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.

UNLABELLED: Issler CK, Monkul ES, Amaral JAMS, Tamada RS, Shavitt RG, Miguel EC, Lafer B. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders. OBJECTIVE: Although bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) is highly prevalent, few controlled studies have assessed this comorbidity. The objective of this study was to investigate the clinical characteristics and expression of comorbid disorders in female BD patients with OCD. METHOD: We assessed clinically stable female outpatients with BD: 15 with comorbid OCD (BD+OCD group) and 15 without (BD/no-OCD group). All were submitted to the Structured Clinical Interview for DSM-IV, with additional modules for the diagnosis of kleptomania, trichotillomania, pathological gambling, onychophagia and skin picking. RESULTS: The BD+OCD patients presented more chronic episodes, residual symptoms and previous depressive episodes than the BD/no-OCD patients. Of the BD+OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the BD/no-OCD patients. The following were more prevalent in the BD+OCD patients than the BD/no-OCD patients: any anxiety disorder other than OCD; impulse control disorders; eating disorders; and tic disorders. CONCLUSION: Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.

Social dysfunction in bipolar disorder: pilot study.

OBJECTIVE: The purpose of the present study was to assess the social skills of euthymic patients with bipolar disorder. METHODS: A group of 25 outpatients with bipolar disorder type I were evaluated in comparison with a group of 31 healthy volunteers who were matched in terms of level of education, age, sex and intelligence. Both groups were assessed using a self-report questionnaire, the Brazilian Inventario de Habilidades Sociais (IHS, Social Skills Inventory). Two Wechsler Adult Intelligence Scale subtests (Picture Arrangement and Comprehension) were also used in order to assess subject ability to analyse social situations and to make judgements, respectively. RESULTS: Patients with bipolar disorder had lower IHS scores for the domains that assessed conversational skills/social self-confidence and social openness to new people/situations. Patients with anxiety disorders had high scores for the domain that assessed self-confidence in the expression of positive emotions. No differences were found between patients and controls in performance on the Wechsler Adult Intelligence Scale Picture Arrangement and Comprehension subtests. CONCLUSIONS: Euthymic patients with bipolar disorder present inhibited and overattentive behaviour in relation to other people and their environment. This behaviour might have a negative impact on their level of social functioning and quality of life.

Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome

OBJECTIVE: Treatment-emergent affective switch has been associated to cycle acceleration and poorer outcome, but there are few studies addressing this issue. The aim of this study was to prospectively compare the outcome of patients presenting treatment-emergent affective switch with patients with spontaneous mania, regarding presence and polarity of a new episode and time to relapse. METHOD: Twenty-four patients with bipolar disorder according to the DSM-IV were followed for 12 months. Twelve patients had treatment-emergent affective switch and twelve had spontaneous mania. Patients were evaluated weekly with the Young Mania Rating Scale and the Hamilton Depression Scale until remission of the index episode, and monthly until completion of the 12-month follow-up. RESULTS: Eleven patients with treatment-emergent affective switch had a recurrence on follow-up, all of them with major depressive episodes. In the group with spontaneous mania, six patients had a recurrence: two had a depressive episode, and four had a manic episode (p = 0.069 for new episode, p = 0.006 for polarity of the episode). Patients with treatment-emergent affective switch relapsed in a shorter period than patients with spontaneous mania (p = 0.016). CONCLUSIONS: In this first prospective study, treatment-emergent affective switch patients were at greater risk of relapses, especially depressive episodes, and presented a shorter duration of remission when compared with patients with spontaneous mania.

OBJETIVO: A ciclagem para mania associada ao antidepressivo tem sido relacionada à aceleração do ciclo e pior evolução, mas há poucos estudos na literatura sobre este assunto. O objetivo deste estudo foi comparar prospectivamente a evolução de pacientes com mania associada a antidepressivo com pacientes com mania espontânea, em relação a tempo para recaída e polaridade do novo episódio. MÉTODO: Vinte e quatro pacientes com transtorno bipolar, de acordo com os critérios diagnósticos do DSM-IV, foram seguidos por 12 meses: 12 pacientes com mania associada a antidepressivo e 12 pacientes com mania espontânea. Os pacientes foram avaliados semanalmente com a Escala para Mania de Young e a Escala para Depressão de Hamilton até remissão do episódio inicial e, mensalmente, até completar o período de seguimento de 12 meses. RESULTADOS: Onze pacientes com mania associada ao antidepressivo tiveram uma recorrência no seguimento, sendo todos os episódios depressivos. No grupo de mania espontânea, seis pacientes apresentaram recorrência, sendo dois episódios depressivos, e quatro episódios de mania (p = 0,069 para novo episódio e p = 0,006 para polaridade do episódio). Pacientes com mania associada a antidepressivo recaíram em um menor período de tempo que os pacientes com mania espontânea (p = 0,016). CONCLUSÕES: Neste estudo prospectivo, os pacientes com mania associada a antidepressivo apresentaram maior risco de recorrência, especialmente episódios depressivos, e com menor duração de remissão quando comparados aos pacientes com mania espontânea.

Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome.

OBJECTIVE: Treatment-emergent affective switch has been associated to cycle acceleration and poorer outcome, but there are few studies addressing this issue. The aim of this study was to prospectively compare the outcome of patients presenting treatment-emergent affective switch with patients with spontaneous mania, regarding presence and polarity of a new episode and time to relapse. METHOD: Twenty-four patients with bipolar disorder according to the DSM-IV were followed for 12 months. Twelve patients had treatment-emergent affective switch and twelve had spontaneous mania. Patients were evaluated weekly with the Young Mania Rating Scale and the Hamilton Depression Scale until remission of the index episode, and monthly until completion of the 12-month follow-up. RESULTS: Eleven patients with treatment-emergent affective switch had a recurrence on follow-up, all of them with major depressive episodes. In the group with spontaneous mania, six patients had a recurrence: two had a depressive episode, and four had a manic episode (p = 0.069 for new episode, p = 0.006 for polarity of the episode). Patients with treatment-emergent affective switch relapsed in a shorter period than patients with spontaneous mania (p = 0.016). CONCLUSIONS: In this first prospective study, treatment-emergent affective switch patients were at greater risk of relapses, especially depressive episodes, and presented a shorter duration of remission when compared with patients with spontaneous mania.

Clinical expression of obsessive-compulsive disorder in women with bipolar disorder.

OBJECTIVE: To study clinical and psychopathological features of obsessive-compulsive disorder (OCD) in women with bipolar disorder (BD). METHODS: Fifteen outpatients with concurrent bipolar disorder I (80.0%) or II (20.0%) and obsessive-compulsive disorder were studied. Most of them (80.0%) sought treatment for bipolar disorder. They were ascertained by means of the Structured Clinical Interview for DSM-IV (SCID/P), semi-structured interviews to investigate obsessions, compulsions and sensory phenomena that may precede compulsions and an additional module for the diagnosis of chronic motor and vocal tics. Severity of symptoms was assessed by the Yale-Brown Obsessive-Compulsive Rating Scale, Hamilton Depression Rating Scale and Young Mania Rating Scale. RESULTS: Obsessive-compulsive disorder presented early onset (before the age of 10) in 9 (60%) cases, preceded bipolar disorder in 10 (66.7%) and displayed chronic waxing and waning course in 13 (86.7%) of them. There was wide overlap between types of obsessive-compulsive symptoms and all patients experienced sensory phenomena preceding the compulsions. There was no clear-cut impact of depressive and manic episodes on the intensity of obsessive-compulsive symptoms, which increased in depression and decreased in mania in 40.0% of the cases, had the opposite pattern in 26.7% of the patients and fluctuated inconsistently in the rest of them. Tics disorders were diagnosed in 5 (33.3%) patients. CONCLUSIONS: Our results suggest that in women with comorbid bipolar disorder and obsessive-compulsive disorder the latter presents features that may be typical of the association of the two disorders, such as early onset and sensory phenomena preceding compulsions. A prospective controlled study is necessary to confirm these observations, due to some limitations of our study: small exclusively female sample, heterogeneity concerning the type of bipolar disorder and the disorder that determined sought of treatment and retrospective non-controlled design.

Clinical expression of obsessive-compulsive disorder in women with bipolar disorder

OBJETIVO: Estudar características clínicas e psicopatológicas do transtorno obsessivo-compulsivo (TOC) em mulheres com transtorno de humor bipolar (THB). MÉTODOS: Foram estudadas, retrospectivamente, 15 pacientes ambulatoriais com diagnósticos simultâneos de transtorno de humor bipolar I (80,0%) ou II (20,0%) e transtorno obsessivo-compulsivo. A maioria havia buscado tratamento para transtorno de humor bipolar (80,0%). A avaliação constou da Entrevista Clínica Estruturada para o DSM-IV (SCID/P), de entrevistas semi-estruturadas para pesquisa de obsessões, compulsões e fenômenos sensoriais que podem preceder as compulsões e de módulo adicional para diagnóstico de tiques motores e vocais crônicos. A gravidade dos sintomas foi investigada através das seguintes escalas: Escala Yale-Brown para Sintomas Obsessivo-Compulsivos, Escala de Avaliação para Depressão de Hamilton e Escala de Avaliação de Mania de Young. RESULTADOS: O transtorno obsessivo-compulsivo teve início precoce em nove (60%) casos, instalou-se antes do transtorno de humor bipolar em 10 (66,7%) e teve curso crônico flutuante em 13 (86,7%). Houve ampla superposição de tipos de sintomas obsessivo-compulsivos e todas as pacientes apresentaram fenômenos sensoriais precedendo as compulsões. Não houve padrão definido no impacto dos episódios depressivos e maníacos na intensidade dos sintomas obsessivo-compulsivos. Estes aumentaram na depressão e diminuíram na mania em 40,0% dos casos; tiveram o comportamento inverso em 26,7% das pacientes e oscilaram de forma inconsistente nas demais. Diagnosticou-se comorbidade com transtorno de tiques em cinco (33,3%) casos. CONCLUSÕES: Nossos resultados sugerem que, em mulheres com comorbidade de transtorno de humor bipolar e transtorno obsessivo-compulsivo, este último apresente características que talvez sejam específicas da associação dos dois transtornos, tais como instalação precoce e presença de fenômenos sensoriais antecedendo as compulsões. A confirmação destas observações em pesquisa prospectiva controlada é necessária, em função de algumas limitações do estudo: casuística reduzida e restrita ao sexo feminino, alguma heterogeneidade da amostra quanto ao tipo de transtorno de humor bipolar e com relação ao transtorno que determinou procura de tratamento, ausência de grupo controle e coleta de dados retrospectiva.

[Anxiety disorders comorbidity in bipolar disorder]. / Comorbidade com transtornos de ansiedade em transtorno bipolar.

High comorbidity between bipolar and anxiety disorders is frequently described in epidemiological and clinical studies. This association has important implications for diagnoses, clinical outcome, therapeutic intervention and prognoses of bipolar disorder that are presented in this review.

Comorbidade com transtornos de ansiedade em transtorno bipolar / Anxiety disorders comorbidity in bipolar disorder

Comorbidade elevada de transtornos de ansiedade em bipolares é freqüentemente relatada em estudos epidemiológicos e clínicos. A associação tem implicações importantes no diagnóstico, evolução clínica, tratamento e prognóstico do transtorno bipolar, que são apresentadas nesta revisão.