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Issler CK, Monkul ES, Amaral JAMS, Tamada RS, Shavitt RG, Miguel EC, Lafer B. Bipolar disorder and comorbid obsessive-compulsive disorder is associated with higher rates of anxiety and impulse control disorders.Objective:Although bipolar disorder (BD) with comorbid obsessive-compulsive disorder (OCD) is highly prevalent, few controlled studies have assessed this comorbidity. The objective of this study was to investigate the clinical characteristics and expression of comorbid disorders in female BD patients with OCD.Method:We assessed clinically stable female outpatients with BD: 15 with comorbid OCD (BD+OCD group) and 15 without (BD/no-OCD group). All were submitted to the Structured Clinical Interview for DSM-IV, with additional modules for the diagnosis of kleptomania, trichotillomania, pathological gambling, onychophagia and skin picking.Results:The BD+OCD patients presented more chronic episodes, residual symptoms and previous depressive episodes than the BD/no-OCD patients. Of the BD+OCD patients, 86% had a history of treatment-emergent mania, compared with only 40% of the BD/no-OCD patients. The following were more prevalent in the BD+OCD patients than the BD/no-OCD patients: any anxiety disorder other than OCD; impulse control disorders; eating disorders; and tic disorders.Conclusion:Female BD patients with OCD may represent a more severe form of disorder than those without OCD, having more depressive episodes and residual symptoms, and being at a higher risk for treatment-emergent mania, as well as presenting a greater anxiety and impulse control disorder burden.

Background: Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. Aims: A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. Method: Subjects were randomized (n = 93) into a CBGT group or a CBGT group with MI+TM. Results: When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. Conclusions: Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Introduction:A variety of subjective experiences have been reported to be associated with the symptom expression of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). First described in TS patients, these subjective experiences have been defined in different ways. There is no consensus in the literature on how to best define subjective experiences. This lack of consensus may hinder the understanding of study results and prevents the possibility of including them in the search for etiological factors associated with OCD and TS.Methods:The objective of this article was to review the descriptions of subjective experiences in the English-language literature from 1980–2007. This meta-analytic review was carried out using the English-language literature from 1980–2007 available on MEDLINE, PsyclNFO, and the Cochrane Library databases using the following search terms: premonitory urges, sensory tics, “just-right” perceptions, sensory phenomena, sensory experiences, incompleteness, “not just-right” phenomena, obsessive-compulsive disorder and TS, including OCD and/or TS, in all combination searches. We also searched for the references cited in each article previously found that referred to the aforementioned terms. Thirtyone articles were included in the study.Results:Subjective experiences, in particular, the sensory phenomena, were important phenotypic variables in the characterization of the tic-related OCD subtype and were more frequent in the early-onset OCD subtype. There is a paucity of studies using structured interviews to assess sensory phenomena, their epidemiology and the etiological mechanisms associated with sensory phenomena.Conclusion:The current review provides some evidence that sensory phenomena can be useful to identify more homogenous subgroups of OCD and TS patients and should be included as important phenotypic variables in future clinical, genetic, neuroimaging, and treatment-response studies.

Introduction Obsessive-compulsive (OC) symptoms may begin at any point of the life span. Comorbid psychiatric disorders in OCD is more a rule than an exception and can contribute to the OCD-related burden. Objectives The goal of this study is to understand the trajectory of comorbid disorders in OCD according to the first manifested psychiatric disorder and their impact in the clinical manifestation of OCD and. Methods 1001 consecutive OCD outpatients from the Brazilian Obsessive-Compulsive Disorder Consortium were evaluated. Inclusion criterion: OCD as the main psychiatric diagnosis (DSM-IV). Exclusion criteria: comorbid schizophrenia and mental retardation. The instruments applied were: SCID-I; Y-BOCS; DY-BOCS, YGTSS (significant level =5%). To investigate the age at comorbidities onset Bayesian approach was performed. Those distributions contain all the information obtained by the data for the mean age at onset. Results OCD patients that presented separation anxiety disorder (N=175, age of onset SAD 5.35) as first diagnosis had higher frequency of social phobia, simples phobia, generalized anxiety disorder and panic disorder (78.3%; p=0.05), somatoform disorders (13.1%; p=0.05) and post-traumatic stress disorder (30.3% p=0.003). OCD patients that presented ADHD (N=50, age of onset ADHD 6.42; age of onset OCD 13.08) as first diagnosis had higher frequency of substance abuse (16.0%; p=0.00001). OCD patients that presented tic disorders (N=44, age of onset tic disorder 6.86; age of onset OCD 16.18) as first diagnosis had higher frequency of OC spectrum disorders (50.0%; p=0.03). Conclusion First psychopathological manifestation in OCD patients is associated with distinct long-term trajectory of comorbid psychiatric disorders.