Amerio Andrea, Tonna Matteo, Odone Anna
Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
Acta Biomed. 2018 Nov 15;89(4):581-584. doi: 10.23750/abm.v89i4.7621.
Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry and it has important nosological and therapeutic implications. Although antidepressantsare the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined.
Longitudinal clinical observation of three severe OCD patients who developed a manic episode during treatment with different classes of antidepressants.
In our cases, three features support the hypothesis of an underlying bipolarity unmasked by the antidepressant used to treat OCD: positive family history for affective disorders, manic switch induced by antidepressantand improvement of affective and obsessive-compulsivesymptoms with mood stabilizers and atypical antipsychotics.
Osler's view that medicine should be treatment of diseases, not of symptoms, is consistent with the approach of mood stabilization as a first objective in BD-OCD patients, as opposed to immediate treatment with antidepressants. Only persistent OCD patients should be prescribed antidepressants in as low a dose as feasible.
双相情感障碍（BD）与强迫症（OCD）之间明显的共病现象在精神病学中很常见，并且具有重要的疾病分类学和治疗意义。尽管抗抑郁药是治疗强迫症的一线药物，但它们可在双相情感障碍患者中诱发情绪不稳定。最佳治疗方法仍有待确定。
对三名在使用不同种类抗抑郁药治疗期间出现躁狂发作的重度强迫症患者进行纵向临床观察。
在我们的病例中，有三个特征支持以下假设，即潜在的双相情感障碍被用于治疗强迫症的抗抑郁药所掩盖：情感障碍的阳性家族史、抗抑郁药诱发的躁狂转换以及使用心境稳定剂和非典型抗精神病药后情感症状和强迫症状改善。
奥斯勒认为医学应治疗疾病而非症状的观点，与将心境稳定作为双相情感障碍合并强迫症患者的首要目标的方法一致，这与立即使用抗抑郁药治疗相反。只有持续性强迫症患者才应尽可能低剂量地使用抗抑郁药。
