IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy.
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy.
J Affect Disord. 2018 Apr 15;231:21-26. doi: 10.1016/j.jad.2018.01.020. Epub 2018 Feb 2.
Growing evidence supports the comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) in children and adolescents. Our aim is to further explore clinical and treatment implications of this comorbidity, as it appears in clinical practice.
The sample included 429 consecutive patients with BD and/or OCD as primary diagnoses, followed for a mean period of 6 months (range 4-9 months), 172 with BD (102 males, mean age 13.7±2.9 years), 169 with OCD (118 males, mean age of 13.2±2.7 years) and 88 with comorbid BD+OCD (56 males, mean age 14.2±2.6 years, 52 with BD as the primary diagnosis), followed for a mean period of 6 months (range 4-9 months). The comorbid group was compared to pure BD and OCD groups, to explore differential clinical and treatment features.
The BD-OCD comorbidity was found in 33.8% of the BD patients and in 34.2% of the OCD patients. Age at onset of BD and OCD were not different in pure and "comorbid" groups. The comorbid group presented a higher occurrence of BD type II and hoarding symptoms, and more frequently received a psychotherapy and second generation antipsychotics, but it presented the poorest outcome in terms of response to treatments. Severity at baseline (clinical severity and functional impairment), hoarding obsessions and compulsions, and conduct disorder comorbidity were associated with a treatment non-response.
A selection bias may have increased the rate of comorbidity, as most of the patients were referred to our tertiary hospital for severe BD and/or OCD and pharmacological treatment. We have used CGI-I as an outcome measure, not a specific measure of BD or OCD symptoms' severity and improvement. The short duration of the follow-up may limit our conclusions.
The timely identification of BD-OCD comorbidity may have relevant clinical implications in terms of symptomatology, course, treatment and outcome.
越来越多的证据支持儿童和青少年双相障碍（BD）和强迫症（OCD）之间的共病。我们的目的是进一步探讨这种共病在临床实践中的临床和治疗意义。
该样本包括 429 名连续患有 BD 和/或 OCD 作为主要诊断的患者，平均随访 6 个月（4-9 个月），其中 172 名患有 BD（102 名男性，平均年龄 13.7±2.9 岁），169 名患有 OCD（118 名男性，平均年龄 13.2±2.7 岁）和 88 名患有共病 BD+OCD（56 名男性，平均年龄 14.2±2.6 岁，52 名以 BD 为主要诊断），平均随访 6 个月（4-9 个月）。将共病组与单纯 BD 和 OCD 组进行比较，以探讨不同的临床和治疗特征。
BD-OCD 共病在单纯 BD 患者中占 33.8%，在单纯 OCD 患者中占 34.2%。单纯和“共病”组的 BD 和 OCD 发病年龄无差异。共病组出现 BD 型 II 和囤积症状的发生率较高，更常接受心理治疗和第二代抗精神病药物治疗，但在治疗反应方面效果最差。基线严重程度（临床严重程度和功能障碍）、囤积性强迫观念和强迫行为以及品行障碍共病与治疗无反应有关。
选择偏倚可能增加了共病的发生率，因为大多数患者被转介到我们的三级医院接受严重的 BD 和/或 OCD 和药物治疗。我们使用 CGI-I 作为结局测量，而不是 BD 或 OCD 症状严重程度和改善的特定测量。随访时间短可能限制了我们的结论。
及时识别 BD-OCD 共病可能对症状、病程、治疗和结局具有重要的临床意义。
