How Does Bipolar Disorder Impact Patients with Obsessive-Compulsive Disorder?

What you need to know

• About 6.2% of patients with primary Obsessive-Compulsive Disorder (OCD) also have Bipolar Disorder (BD).
• OCD patients with comorbid BD have more severe symptoms and require more complex treatment regimens.
• Comorbid OCD and BD patients are more likely to have been hospitalized for psychiatric reasons.

The impact of Bipolar Disorder on OCD patients

Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder (BD) are both challenging mental health conditions on their own. When they occur together, they can create an even more complex clinical picture. This study, conducted by the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), aimed to better understand how often BD occurs in patients with primary OCD and how it affects their clinical characteristics.

Prevalence of Bipolar Disorder in OCD patients

The study found that among 401 patients with primary OCD, 6.2% also had a diagnosis of Bipolar Disorder. This rate is at the lower end of what previous studies have found, which have reported BD comorbidity rates in OCD patients ranging from 6% to 10%. The relatively low rate in this study might be because the sample consisted of patients attending specialized OCD clinics, rather than general psychiatric services where patients with multiple diagnoses might be more common.

Greater illness severity

One of the key findings of this study was that OCD patients with comorbid BD tended to have more severe symptoms. This was measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), a standard tool for assessing OCD symptom severity. Patients with both OCD and BD had significantly higher total scores on this scale compared to those with OCD alone.

The Y-BOCS has two main components - one that measures obsessions and another that measures compulsions. Interestingly, patients with comorbid BD scored higher on both of these subscales. This suggests that the presence of BD is associated with more severe OCD symptoms across the board, rather than just affecting one aspect of the disorder.

More complex treatment needs

Another important finding was that OCD patients with comorbid BD were more likely to be on complex medication regimens. Specifically, they were more likely to be receiving “augmentation therapies” - additional medications used to boost the effectiveness of the primary treatment.

In both groups, the most common augmentation therapy was the use of antipsychotic medications, with risperidone being the most frequently prescribed. However, the use of these additional medications was much more common in the OCD+BD group. This reflects the greater complexity of treating patients with both conditions and the need for more intensive pharmacological interventions.

Higher rates of hospitalization

The study also found that OCD patients with comorbid BD were much more likely to have been hospitalized for psychiatric reasons at some point in their lives. Nearly half (48.2%) of the OCD+BD group had a history of psychiatric hospitalization, compared to only about one-fifth (20.6%) of those with OCD alone.

This higher rate of hospitalization could be due to several factors. It might reflect the overall greater severity of illness in patients with both conditions. It could also be related to the episodes of mania or severe depression that characterize Bipolar Disorder, which often require inpatient treatment.

Potential impact on social functioning

While not reaching statistical significance, the study noted some trends that suggest OCD patients with comorbid BD might face greater challenges in their social and occupational functioning. They were more likely to be living alone, to be divorced, and to be unemployed compared to OCD patients without BD.

These findings, while preliminary, hint at the potential broader impact of having both OCD and BD on a person’s life. The combination of these two conditions might make it more difficult for individuals to maintain relationships and steady employment.

Suicidal risk

The study also looked at suicidal risk among the participants. While there wasn’t a significant difference in the rate of past suicide attempts between the two groups, the researchers noted that current suicide risk was nearly twice as high in the OCD+BD group compared to those with OCD alone (31.3% vs 14.6%). However, this difference didn’t reach statistical significance, possibly due to the relatively small number of patients with both conditions in the study.

This finding underscores the importance of carefully assessing and monitoring suicide risk in patients with both OCD and BD, as they may be at higher risk compared to those with OCD alone.

Conclusions

• The presence of Bipolar Disorder in patients with OCD is associated with more severe OCD symptoms, more complex treatment needs, and a higher likelihood of psychiatric hospitalization.
• While not statistically significant, there were trends suggesting that OCD patients with comorbid BD might face greater challenges in social functioning and have a higher current suicide risk.
• These findings highlight the importance of screening for Bipolar Disorder in OCD patients and vice versa, as the presence of both conditions may significantly impact treatment approaches and overall prognosis.