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.
Abstract
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.
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