1 - Pedopsiquiatria, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Psiquiatria da Infância e da Adolescência – Centro Hospitalar Universitário Lisboa Norte.
- Publicação sob forma de resumo;
- Poster apresentado no 33.º Congresso ECNP
- ECNP Excellence Award
Resumo:
Introduction: Comorbidity between obsessive compulsive disorder (OCD) and bipolar disorder (BD) has been described for decades in adults. However, in the juvenile population, the evidence is much scarcer. The episodic course of OCD in comorbid OCD-BD, the impulsivity in OCD-BD patients and the risk of worsening BD with serotonin reuptake inhibitors configure significant challenges in treating these patients.
Objective: The aim of this review was to explore the effect of OCD-BD comorbidity on both clinical course and therapeutic strategy of each disorder alone.
Method: A scientific review was conducted on a careful analysis of the scientific evidence available on the electronic databases: MEDLINE, Embase and the Cochrane Library.
Results: In children and adolescents, up to one third of the patients with OCD or BD have a lifetime co- occurrence of the other disorder, a much higher prevalence rate compared to adults. Both disorders have a substantial and synergistic impact on clinical presentation and global functioning. The primary diagnosis has characteristically an earlier onset. In the presence of BD, children and adolescents with OCD more frequently experience hoarding or saving obsessions and compulsions, and have a significantly larger number of comorbidities. Compared with BD diagnosis alone, OCD-BD is also associated with greater severity of the characteristic symptoms of BD, greater impulsivity, diminished acute response to pharmacological treatment, higher suicide risk, and unfavourable outcome, including decreased likelihood of remission rates of manic and depressive symptoms. OCD patients receiving polypharmacy presented with higher rates of BD. In addition, OCD-BD patients have higher rates of treatment failure.
Conclusions: OC symptoms in childhood and adolescence may be an expression of vulnerability to BD and are suggestive of partially shared etiopathogenetic mechanisms between these two psychiatric disorders. The literature on pharmacologic and other therapeutic approaches in paediatric OCD-BD patients is limited. It is a challenge to manage children and adolescents with both OCD and BD because antidepressants, first-line agents in OCD, are associated with a switch to mania or rapid cycling in bipolar patients. On the other hand, atypical antipsychotics, used frequently for the treatment of BD, have been reported to induce and exacerbate OC symptoms. This difficulty in treatment decision making involving comorbid OCD and BD may contribute to a poor clinical course. A significant percentage of comorbid patients requires a combination of multiple mood stabilizers.
Palavras Chave: Adolescents, bipolar disorder, child, manic symptoms, obsessive-compulsive disorder.