Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
J Affect Disord. 2019 Apr 15;249:15-19. doi: 10.1016/j.jad.2019.02.024. Epub 2019 Feb 6.
Apparent comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) is a common condition in psychiatry, but treatment of BD-OCD remains a clinical challenge. Although serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD. An optimal treatment approach remains to be defined.
A systematic review was conducted on aripiprazole augmentation in treating comorbid BD-OCD patients. Relevant papers published through August 31st 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.
Aripiprazole augmentation to mood stabilizers (lithium carbonate, valproate), even at low doses (10-15 mg/day), helped to achieve significant remission in affective and obsessive-compulsive symptoms. Aripiprazole was generally safe and well tolerated.
Most studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability.
Keeping in mind scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that aripiprazole augmentation to mood stabilizers, even at low doses, is effective in BD-OCD patients.
双相障碍（BD）和强迫症（OCD）之间明显的共病是精神病学中的常见情况，但 BD-OCD 的治疗仍然是一个临床挑战。尽管选择性 5-羟色胺再摄取抑制剂（SSRIs）是 OCD 的一线治疗药物，但它们会在 BD 中引起情绪不稳定。仍需确定最佳的治疗方法。
对阿立哌唑增效治疗共病 BD-OCD 患者进行了系统评价。通过搜索电子数据库 MEDLINE、Embase、PsycINFO 和 Cochrane Library，确定了截至 2018 年 8 月 31 日发表的相关论文。
阿立哌唑增效治疗心境稳定剂（碳酸锂、丙戊酸钠），即使低剂量（10-15mg/天），也有助于在情感和强迫症症状上实现显著缓解。阿立哌唑通常安全且耐受良好。
大多数研究为病例报告。主要从门诊专科单位招募受试者可能会引入选择偏倚，并限制了在整个社区的普遍性。
考虑到现有文献的稀缺性和异质性，对现有证据的最佳解释似乎是，即使低剂量，阿立哌唑增效治疗心境稳定剂对 BD-OCD 患者也是有效的。
