Kazhungil Firoz, Mohandas E
Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India.
Chief Consultant Psychiatrist, Sun Medical and Research Centre, Trissur, Kerala, India.
Indian J Psychiatry. 2016 Jul-Sep;58(3):259-269. doi: 10.4103/0019-5545.192001.
Obsessive-compulsive disorder (OCD) is one of the most common comorbidities in bipolar disorder (BD). Clinicians often get perplexed in making treatment decisions when encountering comorbid OCD and BD as treatment of OCD by pharmacotherapy may induce or exacerbate mood instability and psychotherapeutic approaches for OCD may not be feasible in acute manic or depressive state of BD. In this study, we reviewed literature, whether existing guideline-based treatments of BD may be effective in OCD and whether newer agents will be of use for treating this comorbidity. We could find that treatment of such comorbid disorder is largely understudied. Adjuvant topiramate or olanzapine- selective serotonin reuptake inhibitor/clomipramine combination along with mood stabilizer is found to be effective for treating OCD in BD. Use of other conventional pharmacological agents and psychotherapy for treating comorbid OCD in BD lacks evidence and is limited to case reports. Our review also highlights the need for further studies regarding the treatment strategies in this highly prevalent comorbid disorder.
强迫症（OCD）是双相情感障碍（BD）最常见的共病之一。临床医生在遇到强迫症和双相情感障碍共病时，往往在做出治疗决策时感到困惑，因为药物治疗强迫症可能会诱发或加剧情绪不稳定，而针对强迫症的心理治疗方法在双相情感障碍的急性躁狂或抑郁状态下可能不可行。在本研究中，我们回顾了文献，探讨基于现有指南的双相情感障碍治疗方法是否对强迫症有效，以及新型药物是否可用于治疗这种共病。我们发现，对这种共病的治疗在很大程度上研究不足。已发现辅助使用托吡酯或奥氮平-选择性5-羟色胺再摄取抑制剂/氯米帕明联合心境稳定剂对治疗双相情感障碍中的强迫症有效。使用其他传统药物和心理治疗来治疗双相情感障碍中的共病强迫症缺乏证据，且仅限于病例报告。我们的综述还强调了对这种高度普遍的共病障碍的治疗策略进行进一步研究的必要性。
