Bidirectional comorbidity between bipolarand obsessive-compulsive disorders: symptoms frequency, treatment challenges and underexplored areas. / Comorbilidad bidireccional entre los trastornos bipolar y obsesivo-compulsivo: frecuencia de síntomas, retos en el tratamiento y áreas sub-exploradas.

  • Trino Baptista Universidad de Los Andes
  • Lisette Galué Universidad de Los Andes
  • Fabiola Martínez Universidad de Los Andes
Palabras clave: categorical diagnosis, comorbidity, mood disorders, obsessive-compulsive disorders, symptoms frequency, comorbilidad, frecuencia de síntomas, trastornos del humor, trastorno obsesivo compulsivo.

Resumen

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.

Resumen.

La alta comorbilidad entre el trastorno bipolar (TB) y el trastorno obsesivo compulsivo (TOC) es un reto para la psiquiatría. Este tema ha sido poco investigado en América Latina, y no encontramos publicaciones de estudios realizados en Venezuela. Dada la dificultad para realizar diagnósticos categóricos en condiciones de comorbilidad, evaluamos la frecuencia de síntomas obsesivo-compulsivos (SOC) actuales, en sujetos con TB primario, y síntomas actuales de trastorno bipolar (STB) en sujetos con TOC primario. Aplicamos la Escala para la Evaluación del TOC de Yale-Brown (Y-BOCS) a 40 pacientes con TB, y la Escala para la Evaluación de Manía Young (YMRS) y el Cuestionario de Trastornos del Humor (MDQ) a 42 pacientes con TOC. Detectamos SOC con significación clínica (puntuación en el Y-BOCS ≥ 16) en 20% de los sujetos con TB, e hipomanía o manía actual en 16,7% y 19% respectivamente, en pacientes con TOC. Detectamos una correlación positiva significativa entre la edad y las puntuaciones en la YMRS en mujeres con TOC, p = 0,04. Confirmamos la alta comorbilidad en las dimensiones del TB y del TOC. Numerosos estudios han identificado la carga clínica, y las dificultades diagnósticas y terapéuticas de esta comorbilidad, la cual requiere investigaciones adicionales para asistir a esta población clínica tan sensible. Finalmente, ilustramos los retos en el tratamiento farmacológico y psicológico y la historia familiar de psicopatología, con dos viñetas clínicas representativas, extraídas de la muestra en estudio.

Citas

Goodman WK, Grice DE, Lapidus KA, Coffey BJ. Obsessive-compulsive disor- der. Psychiatr Clin North Am 2014; 37: 257–67. Doi: 10.1016/j.psc.2014.06.004.PMID 25150561.

Merikangas KR, Akaka HS, Angst J, Gre- enberg PE, Robert MA, Hirschfield, MA, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Sur- vey Replication. Arch Gen Psychiatry 2007; 64(5): 543–552. Doi: 10.1001/archpsyc.64.5.543.

Mayer-Gross W, Slater E, Roth M. Clinical Psychiatry. 3rd. ed. London: Elsevier Health Sciences; 1969, pp. 129.

Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Nassir Ghaemi S. Bipolar I and II disorders; a systematic review and meta analysis on differences in comor- bid obsessive compulsive disorder. Iran J Psychiatry Behav Sci 2016; 10: e 3604.

Cederlöf M, Lichtenstein P, Larsson H, Bo- man M, Rück C, Landén M, Mataix-Cols D. Obsessive-compulsive disorder, psychosis, and bipolarity: A longitudinal cohort and multigenerational family study. Schizophr Bull 2015; 41: 1076-1083. Doi: 10.1093/schbul/sbu169.

Swets M, Van Dael F, Roza S, Schoevers R, Myin-Germeys I, de Haan L. Genetic risk and outcome of psychosis (GROUP). Evi- dence for a shared etiological mechanism of psychotic symptoms and obsessive-com- pulsive symptoms in patients with psycho- tic disorders and their siblings. PLoS ONE| Doi: 10.1371/journal.pone.0125103 June 10, 2015.

American Psychiatric Association. Diag- nostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5TM. Washing- ton DC. 2013; pp. 13.

Sharma LP, Reddy YC. Obsessive–compul- sive disorder comorbid with schizophrenia and bipolar disorder. Indian J Psychiatry 2019; 61: S140-148.

Amaral JA, Tamada RS, Schwartzmann AM, Shavitt RG, Miguel EC, Lafer B. Cli- nical expression of obsessive-compulsive disorder in women with bipolar disorder. Braz J Psychiatry 2005; 27:139-142. Doi:10.1590/s1516-44462005 000200013.

Kapczinski NS, Kapczinski F. Correlates and impact of obsessive-compulsive comor- bidity in bipolar disorder. Compr Psychiatry 2010; 51: 353-356. Doi: 10.1016/j.compp- sych.2009.11.001.

Domingues-Castro MS, Torresan RC, Sha- vitt RG, Fontenelle LF. Bipolar disorder comorbidity in patients with obsessive-com- pulsive disorder: Prevalence and predictors. J Affect Disord 2019; 256: 324-330. Doi: 10.1016/j.jad.2019.06.018.

First MB, Spitzer RL, Gibbon M, Williams JBW. User´s Guide for the Structured Cli- nical Interview for DSM-IV Axis I Disorders: Clinical Version. American Psychiatric Asso- ciation Publishing. Washington DC, 1997.

Colom F, Vieta E, Martine-Aran A, García M, Reinares M, Torrent C, Goikolea JM, Banus S, Salamero M. Versión española de una escala de evaluación de la mania: vali- dez y fiabilidad de la escala de Young. Med Clin (Barc) 2002; 119: 366-371.

Araque Y. Validacion de la Escala de evalua- ción de trastornos afectivos (MDQ) en Ve- nezuela. Thesis. Universidad de Los Andes Medical School, Mérida, Venezuela, 2010.

Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, Char- ney DS. The Yale-Brown Obsessive Compul- sive Scale. I. Development, use, and relia- bility. Arch Gen Psychiatry 1989; 46 (11):1006-1011.

Farris SG, McLean CP, Van Meter PE, Simpson HB, Foa EB. Treatment response, symptom remission and wellness in obses- sive-compulsive disorder. J Clin Psychia- try 2013; 74: 685-690. Doi: 10.4088/ JCP.12m07789.

Baptista T, Araujo, H, deLeon J. Successful clozapine augmentation after brain surgery in a subject with severe primary obsessive- compulsive disorder. J Clin Psychopharma- col 2019; 39: 86-87.

Publicado
2021-01-13
Sección
Trabajos Originales