Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista (UNESP), Brazil.
Department and Institute of Psychiatry, University of São Paulo (USP), Brazil.
J Affect Disord. 2019 Sep 1;256:324-330. doi: 10.1016/j.jad.2019.06.018. Epub 2019 Jun 7.
Patients with obsessive-compulsive disorder (OCD) often present with comorbidities, mainly anxiety and affective disorders, which may influence OCD course, help-seeking and treatment response. Some authors have studied bipolar disorder (BD) comorbidity in patients with OCD, but usually in small samples. The objective was to estimate the lifetime prevalence of BD in a large clinical sample of OCD patients, and to compare demographic and clinical features of patients with and without BD comorbidity.
This cross-sectional study with 955 adult OCD patients from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC) used several assessment instruments, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Beck Depression and Anxiety Inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Descriptive and bivariate analyses were followed by logistic regression.
The lifetime prevalence of BD was 7.75% (N = 74). The variables that were independently associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders, and suicide attempts.
The cross-sectional design does not permit causal inferences; the external validity may be limited, as the participants were from tertiary services. Despite the large sample size, some analyses may have been underpowered due to the relatively low prevalence of the outcome and of some explanatory variables.
Patients with OCD comorbid with BD have some clinical features indicative of greater severity, including higher suicide risk, and require a careful therapeutic approach for the appropriate treatment of both disorders.
强迫症（OCD）患者常伴有共病，主要为焦虑和情感障碍，这可能影响 OCD 的病程、求助和治疗反应。一些作者研究了 OCD 患者的双相障碍（BD）共病，但通常样本较小。本研究旨在估计 OCD 患者大临床样本中 BD 的终生患病率，并比较伴或不伴 BD 共病患者的人口统计学和临床特征。
本横断面研究纳入了来自巴西强迫症谱系障碍研究联盟（C-TOC）的 955 名成年 OCD 患者，使用了耶鲁-布朗强迫量表、维度耶鲁-布朗强迫量表、贝克抑郁和焦虑量表以及 DSM-IV 轴 I 障碍的结构临床访谈等评估工具。采用描述性和双变量分析，然后进行逻辑回归。
BD 的终生患病率为 7.75%（N=74）。与 BD 共病独立相关的变量是：伴有广场恐怖症的惊恐障碍、冲动控制障碍和自杀企图。
横断面设计不允许进行因果推断；由于参与者来自三级服务机构，外部有效性可能有限。尽管样本量较大，但由于结局和一些解释变量的患病率较低，某些分析可能效力不足。
伴 BD 的 OCD 患者有一些提示更严重程度的临床特征，包括更高的自杀风险，需要采用精心的治疗方法来治疗两种疾病。
