Inpatient Mental Health Service, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
Rita Levi Montalcini Department of Neuroscienze, University of Turin, Turin, Italy; San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
J Affect Disord. 2019 Sep 1;256:433-440. doi: 10.1016/j.jad.2019.06.015. Epub 2019 Jun 6.
In the last five years, the debate around the comorbidity between bipolar disorder (BD) and obsessive-compulsive disorder (OCD) has flourished within the international psychiatric community and several studies have been published on therapeutic strategies.
An update of our previous systematic review was conducted on clinical management of comorbid BD-OCD patients. Relevant papers published from July 1st 2013 to September 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.
Fifteen studies were included. In all selected studies BD-OCD patients received mood stabilizers, alone or with second-generation antipsychotics (SGAs). Aripiprazole augmentation demonstrated to be effective as maintenance therapy and for treating obsessive-compulsive symptoms during manic episodes (40% of the studies, 6/15). Addition of antidepressants to mood stabilizers led to clinical remission of both conditions in only one case report.
Almost 50% of the selected studies are case reports. Enrolment of subjects mainly from outpatient specialty units might have introduced selection bias and limited community-wide generalizability.
Mood stabilization should be the primary goal in treating BD-OCD patients. Aripiprazole augmentation to lithium carbonate seemed to be the best option in treatment-resistance comorbid patients. Addition of SRIs may be needed only in a minority of BD patients with refractory OCD.
在过去的五年中，国际精神病学界围绕双相情感障碍（BD）和强迫症（OCD）共病的争论愈演愈烈，并且已经发表了几项关于治疗策略的研究。
我们对 BD-OCD 患者的临床管理进行了先前系统评价的更新。通过检索电子数据库 MEDLINE、Embase、PsycINFO 和 Cochrane Library，从 2013 年 7 月 1 日至 2018 年 9 月 30 日，确定了相关的已发表文献。
共纳入了 15 项研究。在所有选定的研究中，BD-OCD 患者接受了心境稳定剂，单独或联合第二代抗精神病药（SGAs）治疗。阿立哌唑增效治疗被证明对维持治疗和治疗躁狂发作期间的强迫症状有效（40%的研究，6/15）。在仅有的 1 项病例报告中，将抗抑郁药添加到心境稳定剂中可使两种疾病均缓解。
所选研究中近 50%为病例报告。主要从门诊专科单位招募的受试者可能存在选择偏倚，限制了其在社区范围内的普遍适用性。
稳定情绪应是治疗 BD-OCD 患者的首要目标。阿立哌唑增效锂碳酸盐似乎是治疗抵抗性共病患者的最佳选择。仅有少数难治性 OCD 的 BD 患者可能需要添加 SSRIs。
