Impact of obsessive-compulsive disorder comorbidity on the sociodemographic and clinical features of patients with bipolar disorder

Background

In this study, our aim is to determine the prevalence rates of obsessive-compulsive disorder (OCD) comorbidity and to assess the impact of OCD comorbidity on the sociodemographic and clinical features of patients with bipolar disorder (BD).

Methods

Using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-IV/Clinical Version on bipolar patients, 2 groups, BD with OCD comorbidity (BD-OCD) and BD without OCD comorbidity, were formed. These groups were compared for sociodemographic and clinical variables.

Results

Of 214 patients with BD, 21.9% of them had obsession and/or compulsion symptoms and 16.3% had symptoms at the OCD level. Although there was no statistically significant difference between the frequency of comorbid OCD in BD-I (22/185, 11.9%) and BD-II (3/13, 23.1%) patients, but OCD was found to be significantly high in BD not otherwise specified (10/16, %62.5) patients than BD-I (P < .001) and BD-II (P = .03). Six patients (17.1%) of the BD-OCD group had chronic course (the presence of at least 1 mood disorder episode with a duration of longer than 2 years), whereas the BD without OCD group had none, which was statistically significant. There were no statistically significant differences between BD-OCD and BD without OCD groups in terms of age, sex, education, marital status, polarity, age of BD onset, presence of psychotic symptoms, presence of rapid cycling, history of suicide attempts, first episode type, and predominant episode type.

Limitations

Main limitation of our study was the assessment of some variables based on retrospective recall.

Conclusions

Our study confirms the high comorbidity rates for OCD in BD patients. Future studies that examine the relationship between OCD and BD using a longitudinal design may be helpful in improving our understanding of the mechanism of this association.     

Quality of life and anxiety and depressive disorder comorbidity

The present investigation evaluated the relations among anxiety and depressive disorder comorbidity and quality of life (QOL) by utilizing self-report measures of life satisfaction and functional disability. Participants were 94 individuals who were presented for treatment at an outpatient anxiety disorders clinic and 26 nonclinical participants. Results indicated that participants diagnosed with anxiety disorders reported lower QOL than did nonclinical participants. Anxiety disorder comorbidity did not additionally impact QOL; however, presence of a depressive disorder comorbid with an anxiety disorder did negatively impact QOL as these individuals reported significantly more functional disability and less life satisfaction than did individuals with anxiety disorders alone or those without a psychiatric diagnosis. These results highlight the negative nature of anxiety disorders and improve clarification on the role of diagnostic comorbidity on QOL among those with an anxiety disorder.     

Headache and anxiety–depressive disorder comorbidity: the HADAS study

Neurological Sciences - Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients,...     

强迫症与分裂型障碍共病的临床研究

目的调查强迫症患者的分裂型症状以及分裂型障碍共病发生比率并探讨伴有分裂型障碍的强迫症的临床特点。方法201例门诊强迫症患者,符合ICD-10与DSM-IV强迫症诊断标准,进行强迫症相关的一系列临床评定和ICD-10分裂型障碍症状评定,并分析分裂型症状与临床变量的关系,然后对伴有分裂型障碍的强迫症和单纯强迫症进行临床对照。结果31.3%(63/201)强迫症患者伴有3条或3条以上的分裂型障碍症状,28.4%(57/201)的强迫症患者同时存在ICD-10分裂型障碍。在9条ICD-10分裂型障碍症状中出现率比较高的依次是无内在阻力的强迫思维、古怪的信念或巫术性思想、不寻常的知觉体验、思维形式障碍(如赘述)等。有短暂的幻觉或妄想样信念者占9%。相关分析显示分裂型症状与强迫症状荒谬性(r=0.699,P<0.001)、抵抗力弱(r=0.5,P<0.001)、自知力不良(r=0.453,P<0.001)、残疾程度(r=0.328,P<0.001)等临床变量正相关。与单纯强迫症相比,伴有分裂型障碍者起病相对较急(P<0.05)、强迫症状比较荒谬、患者对症状顺从、自知力差、病情与社会功能障碍较重(P<0.001)。结论部分强迫症患者同时存在分裂型症状并符合分裂型障碍的诊断标准,分裂型症状与强迫症的某些临床特点相关,伴有分裂型障碍的强迫症倾向强迫症状荒谬、患者对症状抵抗较弱、自知力不良、病情较严重、社会功能损害较重。     

Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder

ObjectiveTo examine the impact of psychiatric comorbidity on cognitive-behavioral therapy response in children and adolescents with obsessive-compulsive disorder.MethodNinety-six youths with obsessive-compulsive disorder (range 7-19 years) received 14 sessions of weekly or intensive family-based cognitive-behavioral therapy. Assessments were conducted before and after treatment. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, response rates, and remission status.ResultsSeventy-four percent of participants met criteria for at least one comorbid diagnosis. In general, participants with one or more comorbid diagnoses had lower treatment response and remission rates relative to those without a comorbid diagnosis. The number of comorbid conditions was negatively related to outcome. The presence of attention-deficit/hyperactivity disorder and disruptive behavior disorders was related to lower treatment response rates, and the presence of disruptive behavior disorders and major depressive disorder were related to lower remission rates.ConclusionsThe presence of a comorbid disorder, particularly disruptive behavior, major depressive, and attention-deficit/hyperactivity disorders, has a negative impact on treatment response. Assessing for psychiatric disorders before treatment entry and treating these comorbid conditions before or during cognitive-behavioral therapy may improve final outcome. Comorbid anxiety or tic disorders do not seem to negatively affect response.     

Heterogeneity and comorbidity of obsessive-compulsive disorder

Although the DSM-IV-TR suggests that obsessive-compulsive disorder (OCD) is a coherent syndrome, scientific evidence offers a compelling case that OCD is highly heterogeneous and possibly composed of many different subtypes. OCD can display completely distinct symptom patterns thus making it difficult to identify a single "textbook" profile of OCD. The present state of research concerning subtyping is presented. There is a high comorbidity with depression and anxiety disorders, but all together data concerning OCD comorbidity are still not convincing. Currently obsessive-compulsive spectrum disorders (OCS) are described as a set of disorders lying on a continuum from compulsive to impulsive, with the unifying feature being an inability to regulate behaviour as a consequence of defects in inhibition. OCS disorders fall into three major clusters: impulsive disorders, disorders associated with appearance in bodily sensations, and neurological disorders characterized by repetitive behaviour. How these putative OCS disorders overlap with and are independent from obsessive-compulsive disorder itself is thoroughly discussed.     

The clinical impact of mood disorder comorbidity on social anxiety disorder

Background

High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD.

Methods

The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared.

Results

Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD.

Conclusions

Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD.     

Diagnosis of multiple anxiety disorders predicts the concurrent comorbidity of major depressive disorder

Purpose

It has been established that a single anxiety disorder (AD) is more likely to be comorbid with other ADs as well as major depressive disorder (MDD). However, little is known about the comorbidity risks of MDD in patients with double or multiple ADs in comparison with those with a single AD. In this study, we estimated the comorbidity risks of MDD in patients with multiple ADs.

Method

The subjects were 217 consecutive outpatients with any ADs who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview. The comorbidity rates of MDD in subjects with 2 or more ADs were compared with those in subjects with a single AD.

Results

The comorbidity rates of MDD in subjects with a single AD (n = 119), 2 ADs (n = 75), and 3 or more ADs (n = 23) were 20.1%, 45.3%, and 87.0%, respectively. The relative risks of the comorbidity of MDD in subjects with 2 and with 3 or more ADs compared with those with a single AD were 3.3 (95% confidence interval, 1.7-6.3) and 26.4 (95% confidence interval, 8.2-118.7), respectively. Generalized anxiety disorder was associated with a higher comorbidity rate of MDD in subjects with a single AD but not in subjects with 2 or more ADs.

Conclusion

The results showed that the presence of multiple ADs strongly predicts comorbidity with MDD in an exponential manner, suggesting that we should pay attention to the fact that patients with multiple ADs are more likely to be comorbid with MDD.     

老年焦虑抑郁障碍共病54例临床研究

目的 探讨老年焦虑抑郁障碍的临床特征、诊断及治疗方法.方法 选取54例符合入组标准及排除标准的患者进行临床研究,归纳临床症状并进行统计分析.用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分,对比治疗前后的评分变化,并以HAMA和HAMD减分率判定疗效.结果 老年焦虑障碍多与抑郁共病,躯体主诉多为其主要特点.治疗后第2周末开始起效,疗效随时间延长同步上升,治疗后第2、4、8周末HAMA、HAMD量表评分与治疗前比较,有显著性差异(P ＜0.05,P＜0.01).药物及心理治疗的总有效率90.75％.结论 老年焦虑障碍多与抑郁共病,及时干预治疗效果满意.     

焦虑症共病抑郁症状在门诊患者中的调查研究

目的调查门诊患者中焦虑症的患病率以及共病抑郁症状的发生率。方法在我院精神科门诊、心理咨询门诊以及社区卫生服务中心内科门诊就诊的1106例患者作为研究对象，并做SAS、SDS、HAMA量表评定。结果1106例患者中，符合焦虑症诊断，且HAMA≥14分者共93例，患病率为8.41%。SDS标准分≥50共病抑郁症状的共43例，占46.23%。HAMA分值、SAS分值与SDS分值有显著性正相关。结论门诊中罹患焦虑症的患者焦虑程度越高，共病抑郁的可能性就越大。     

Impact of depressive symptoms on the treatment of generalized social anxiety disorder

Patients with depression are often excluded from studies on the treatment of social anxiety disorder (SAD), leaving gaps in our knowledge about the impact of depressive affect on treatment for SAD. Patients participated in a randomized, placebo-controlled study of treatment for SAD. As in previous studies, patients were excluded from the study if they met criteria for major depressive disorder in the past 6 months. This exclusion notwithstanding, patients who enrolled in the study exhibited a range of depressive symptoms, permitting an examination of the impact of depressive symptoms on treatment outcome for SAD. Assessment measures included the Clinical Global Impression Scale, Hamilton Rating Scale for Depression, Brief Social Phobia Scale, and Beck Depression Inventory. Higher levels of depressive symptoms were related to more severe social anxiety overall, and to less change in social anxiety symptoms over the course of the study. Patients who were deemed nonresponders to treatment had higher levels of depressive symptoms at pretreatment than those who responded. In addition, patients who dropped out of the study had higher levels of depressive symptoms at pretreatment than those who completed the study. These results suggest that modifications should be made to existing treatments to improve outcomes and decrease attrition in the substantial proportion of patients with SAD who also evidence depressive symptoms. Such modifications are likely to be more important when treating patients with SAD and comorbid major depressive disorder.     

强迫症与焦虑关系的临床资料分析

目的探讨强迫与焦虑的关系。方法采用Foa的分类,将100例强迫症患者按焦虑程度（SCL-90焦虑因子）分为三组进行比较分析。结果100例患者中伴焦虑者占79％,伴抑郁者占74％;高焦虑组病程长于低焦虑组（P〈0．05）Foa分型中,高焦虑组以Ⅰ、Ⅱ和Ⅵ型多见;临床表现以强迫恐惧的焦虑分高于污染／检查、强迫意象／表象、强迫思考、强迫性犹豫不决和强迫观念（P〈0．01）。结论强迫症与焦虑的关系确有Foa等提出的八种临床类型;强迫症患者伴焦虑的程度并不完全取决于病程,而是致焦虑性强迫想法与减焦虑性强迫反应相互作用的结果。     

Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder.

OBJECTIVE: Generalized anxiety disorder (GAD) in elderly persons is highly prevalent, but little is known about its course, age at onset, and relationship to comorbid major depressive disorder (MDD). The authors assessed the course and comorbidity of late-life GAD and MDD. METHODS: Authors assessed elderly subjects in anxiety or depression intervention studies who had a lifetime history of GAD, with current MDD (N=57) or without (N=46). Subjects' lifetime course of illness was charted retrospectively. RESULTS: The 103 subjects had a mean age of 74.1 years, and a mean age at onset of GAD of 48.8 years; 46% were late-onset. GAD episodes were chronic, and 36% were longer than 10 years. Of the comorbid GAD-MDD patients, most had different times of onset and/or offset of the disorders; typically, GAD preceded MDD. CONCLUSIONS: Elderly subjects with GAD tended to have chronic symptoms lasting years-to-decades, without interruption, and many have late onset. Elderly persons with lifetime GAD and MDD tend to have different onset and offset of the two disorders. Findings characterize late-life GAD as a chronic disorder distinct from MDD.     

Eating disorder symptoms among female anxiety disorder patients in clinical practice: the importance of anxiety comorbidity assessment

This exploratory study investigated the relationship between anxiety disorders, anxiety comorbidity, and eating disorder (ED) symptoms in clinical practice, and examined the naturalistic detection of ED when diagnoses were based on the Anxiety Disorders Interview Schedule (ADIS). Two hundred and fifty-seven female patients completed an ED questionnaire and were assessed with the ADIS. Although ED frequency did not differ among anxiety disorder diagnoses, regression analyses revealed that social phobia (SP) and posttraumatic stress disorder (PTSD) accounted for unique variance in eating pathology. Questionnaire results indicated that almost 12% of patients met criteria for a possible ED. Clinicians using the ADIS evidenced good specificity but were not sensitive to detecting ED, missing 80% of possible cases. Results support possible links between ED, social phobia and PTSD and highlight the importance of assessing anxiety comorbidity when examining the relationship between ED and anxiety disorders. Results also suggest that formal screening for ED among female anxiety patients may be warranted.     

Correlates and impact of obsessive-compulsive comorbidity in bipolar disorder

Background

Anxiety morbidity in general is frequent and harmful in bipolar disorder. Little is known, however, whether obsessive-compulsive comorbidity entails particular effects. This report aims to evaluate the prevalence and impact of obsessive-compulsive disorder (OCD) comorbidity in a relatively large clinical sample of bipolar disorder, with other lifetime anxiety comorbidities used as a more rigorous control group.

Methods

A cross-sectional study in a consecutive clinical sample, with anxiety comorbidity derived from the intake Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was conducted. Anxiety was assessed with the Hamilton Anxiety Rating Scale. The Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to assess (hypo)manic and depressive symptoms. The domains of the WHOQOL BREF were used to evaluate quality of life.

Results

Lifetime prevalence of OCD comorbidity was 12.4%. No cases of OCD were detected during mania. Compared with subjects with no anxiety comorbidity, those with lifetime OCD were more likely to have a history of suicide attempts, rapid cycling, and alcohol dependence. Patients with OCD had a lower score on all domains of the WHOQOL. Compared with those with other lifetime anxiety disorders, those with OCD had more anxiety, which mediated a lower WHOQOL social domain.

Conclusions

Bipolar disorder patients with obsessive-compulsive comorbidity have a number of indicators of an overall more severe illness. The presence of more anxiety symptoms and a lower social quality of life may be more specific features of the bipolar-OCD comorbidity.     

Symptom dimensions,clinical course and comorbidity in men and women with obsessive-compulsive disorder

The study aimed to compare male and female patients with obsessive-compulsive disorder (OCD) across symptom dimensions, clinical course and comorbidity. A cross-sectional study was undertaken with 858 adult OCD patients (DSM-IV) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were evaluated using structured interviews, including the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sample was composed of 504 women (58.7%) and 354 men (41.3%) with a mean age of 35.4 years-old (range: 18–77). Men were younger, more frequently single and presented more tics, social phobia and alcohol use disorders. Among men, symptom interference occurred earlier and symptoms of the sexual/religious dimension were more common and more severe. Conversely, women were more likely to present symptoms of the aggressive, contamination/cleaning and hoarding dimension and comorbidity with specific phobias, anorexia nervosa, bulimia, trichotillomania, skin picking and “compulsive” buying. In the logistic regression, female gender remained independently associated with the aggressive and contamination/cleaning dimensions. In both genders the aggressive dimension remained associated with comorbid post-traumatic stress disorder, the sexual/religious dimension with major depression and the hoarding dimension with tic disorders. Gender seems to be relevant in the determination of OCD clinical presentation and course and should be considered an important aspect when defining more homogeneous OCD subgroups.     

Dissociative symptoms and dissociative disorder comorbidity in patients with obsessive-compulsive disorder

The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessive-compulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms. All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.