Comorbid Obsessive-compulsive Disorder Research Articles

Co-morbid obsessive-compulsive disorder and depression: a Bayesian network approach.

Obsessive-compulsive disorder (OCD) is often co-morbid with depression. Using the methods of network analysis, we computed two networks that disclose the potentially causal relationships among symptoms of these two disorders in 408 adult patients with primary OCD and co-morbid depression symptoms. We examined the relationship between the symptoms constituting these syndromes by computing a (regularized) partial correlation network via the graphical LASSO procedure, and a directed acyclic graph (DAG) via a Bayesian hill-climbing algorithm. The results suggest that the degree of interference and distress associated with obsessions, and the degree of interference associated with compulsions, are the chief drivers of co-morbidity. Moreover, activation of the depression cluster appears to occur solely through distress associated with obsessions activating sadness - a key symptom that 'bridges' the two syndromic clusters in the DAG. Bayesian analysis can expand the repertoire of network analytic approaches to psychopathology. We discuss clinical implications and limitations of our findings.

An epidemiological study of prevalence and comorbidity of obsessive compulsive disorder symptoms (SOCD) and stress in Pakistani Adults.

Objective:To investigate the prevalence and comorbidity of subclinical obsessive compulsive disorder (SOCD) symptoms and stress across gender, marital and employment statuses.Methods:A cross-sectional research was conducted from December, 2016 to March 2017 at two universities of cosmopolitan city Lahore. Two self-report scales measuring SOCD symptoms and stress were used to collect data from 377 adults selected through simple random sampling technique, proportionately distributed across gender, marital and employment status.Results:From the total sample, 52% reported low level of stress and 48% faced high level of stress. Significant differences in prevalence were observed across marital and employment statuses whereas for men and women, it was observed same (24%). Comorbidity of high level of SOCD symptoms and high level of stress was seen 34%.Conclusion:Significant prevalence and comorbidity exists between SOCD symptoms and stress and more studies addressing diverse population are needed.

Characterisation of body dysmorphic disorder (BDD) versus obsessive-compulsive disorder (OCD): In light of current DSM-5 nosology

•We present a comparative study of clinical characteristics in BDD versus OCD.•Comorbid mood and anxiety disorders were prevalent in both disorders.•Comorbid OCD in primary BDD (33.3% lifetime) was more prevalent than vice versa.•Avoidant and obsessive-compulsive PDs were common in BDD and OCD respectively.•Insight was significantly more impaired in BDD, despite comparable illness severity.

A Case Report of Intensive Exposure-Based Cognitive Behavioral Therapy for a Child With Comorbid Autism Spectrum Disorder and Obsessive-Compulsive Disorder

Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) has proven to be an effective treatment modality for children with obsessive-compulsive disorder (OCD). Less research exists demonstrating efficacy for this treatment modality among children with comorbid diagnoses of OCD and autism spectrum disorder (ASD), and virtually, nothing has been reported examining intensive interventions for the most severe cases. As such, this article discusses the treatment of an adolescent male with severe OCD comorbid with ASD, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), and chronic tic disorder using a cognitive behavioral approach and ERP. We conclude with recommendations for continued clinical research to understand approaches to help nonresponders to standard therapeutic approaches with this challenging population.

Trigeminal nerve stimulation for the treatment of major depressive disorder and obsessive-compulsive disorder: a case study

Neuromodulation techniques have been proposed as add-on strategies for modulating brain areas involved in obsessive-compulsive disorder symptoms. Trigeminal nerve stimulation is a novel neuromodulation technique, which, to date, has not yet been explored for obsessive-compulsive disorder treatment. In this report, we describe a 52-year-old female patient suffering from major depressive disorder and obsessive-compulsive disorder for 18 and 32 years, respectively and successfully undergoing a trigeminal nerve stimulation intervention protocol (10 consecutive daily trigeminal nerve stimulation sessions), with amelioration of symptoms. Cognitive function was not obviously altered as assessed by the Montreal Cognitive Assessment. Major depressive disorder and obsessive-compulsive disorder symptoms assessed using the Yale-Brown Obsessive-Compulsive Scale and the 17-item Hamilton Depression Rating Scale substantially improved after the 10-day treatment course and remained stable after 1-month follow-up (30 days after final trigeminal nerve stimulation). The patient reported significant global clinical gains and mild diurnal sleepiness without severe adverse effects. Trigeminal nerve stimulation has been studied for the treatment of various neuropsychiatric disorders that share common functional alterations at the frontal cortex and subcortical areas, usually altered in obsessive-compulsive disorder. We present the first case report on trigeminal nerve stimulation for co-morbid obsessive-compulsive disorder and major depressive disorder. These encouraging results should be seen as hypothesis-driving for further controlled randomized trials exploring the impact of trigeminal nerve stimulation in the treatment of obsessive-compulsive disorder.

Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles

Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention.We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99–3.09) and OCD symptoms (ds=1.64–2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [−0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.

Modified Exposure and Response Prevention for the Treatment of Comorbid OCD-Like Repetitive Behavior and Developmental Disability

Adults with developmental disabilities are particularly vulnerable to experiencing obsessive-compulsive disorder (OCD). However, the application of evidence-based treatments such as Exposure and Response Prevention (ERP) to individuals with comorbid OCD and developmental disabilities is a relatively new and emerging field of study. The present article presents a case study of modified ERP for the treatment of an adult woman with comorbid OCD-like repetitive behavior and developmental disabilities. Target behaviors, including OCD-like repetitive behavior, verbal agitation, and physical aggression, decreased over the course of the 7-month active treatment phase, and reductions in physical aggression and verbal agitation were maintained during follow-up. This case study provides important lessons about the individual-level and systems-level assessment and treatment of comorbid OCD-like repetitive behavior and developmental disabilities.

The Clinical Characteristics of ADHD and Obsessive-Compulsive Disorder Comorbidity

Objective: To investigate the clinical implications of obsessive-compulsive disorder (OCD) and ADHD comorbidity in adults. Method: The OCD patients who had and had no diagnosis of adulthood ADHD were compared in terms of several demographic and clinical variables. Results: The mean number of obsessions and compulsions; hoarding, symmetry, and miscellaneous obsessions; ordering/arranging and hoarding compulsions; total, attentional, and motor subscale scores of Barratt Impulsivity Scale (BIS)-11 were more frequent among the patients with OCD-ADHD. The mean age of onset was more likely to be earlier in ADHD-OCD group than in OCD group. Impulsivity, symmetry obsessions, and hoarding compulsions strongly predicted the coexistence between ADHD and OCD. Conclusion: OCD-ADHD comorbidity in adults seemed to be associated with an earlier onset of OCD, with the predominance of impulsivity, and with a different obsessive-compulsive symptom (OC) profile from OCD patients without a diagnosis of ADHD.

The Features of Comorbidity of Childhood ADHD in Patients With Obsessive Compulsive Disorder

Objective: Our aim is to investigate the impact of childhood ADHD comorbidity on the clinical features of obsessive compulsive disorder (OCD). Method: Ninety-five adult outpatients with a diagnosis of OCD were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version, ADHD module, and the Yale–Brown Obsessive Compulsive Scale. Patients with or without childhood ADHD were compared in terms of the sociodemographic and clinical features, psychiatric comorbidities, and rating scales. Results: The rate of episodic course of OCD (p < .001), religious and sexual obsessions (p = .009, p = .020, respectively), lifetime comorbidity of bipolar disorder (BD), social anxiety disorder (SAD; p = .001, p = .009, respectively), and tic disorder (TD) comorbidity (p < .001) were higher in the OCD + ADHD group than in the OCD without ADHD group. Conclusion: Childhood ADHD may be associated with higher rates of BD, SAD, and TD comorbidity and episodic course of OCD as well as higher frequency of certain types of obsessions.

Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome.

Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.

Withdrawn/Depressed Behaviors and Error-Related Brain Activity in Youth With Obsessive-Compulsive Disorder

The pathophysiology of obsessive-compulsive disorder (OCD) involves increased activity in corticostriatal circuits connecting the anterior cingulate cortex with other brain regions. The error-related negativity (ERN) is a negative deflection in the event-related potential after an incorrect response that is believed to reflect anterior cingulate cortex activity. This study examined the relation of the ERN to OCD symptom dimensions and other childhood symptom dimensions. The ERN, correct response negativity, and accuracy were measured during a flanker task to assess performance monitoring in 80 youth with a lifetime diagnosis of OCD and 80 matched healthy comparison participants ranging from 8 to 18 years old. The relation of the ERN to OCD symptom dimension scores and Child Behavior Checklist Syndrome Scale scores was examined in multiple linear regression analyses. Accuracy was significantly decreased and ERN amplitude was significantly increased in patients compared with controls. ERN amplitude in patients was significantly correlated with accuracy, but not with OCD symptom dimensions, severity, comorbidity, or treatment. In a multiple linear regression analysis using age, accuracy, OCD, and Child Behavior Checklist Syndrome Scale scores as predictors of ERN amplitude, the ERN had significant associations only with Withdrawn/Depressed Scale scores and accuracy. An enlarged ERN is a neural correlate of pediatric OCD that is independent of OCD symptom expression and severity. The finding of lower accuracy in pediatric cases requires replication. The relation between an enhanced ERN and withdrawn/depressed behaviors warrants further research in youth with OCD and other internalizing disorders.

Psychiatric Comorbidity in Obsessive Compulsive Disorder: Severity of Anxiety and Depression

Psychiatric Comorbidity in Obsessive Compulsive Disorder: Severity of Anxiety and Depression

An approach to comorbidity between obsessive-compulsive disorder and schizophrenia

IntroductionAn association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.ObjectiveTo analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.MethodReview of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.ResultsSome studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.ConclusionsThe simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients.

Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes.

The Use of Quetiapine for Comorbid Bipolar and Obsessive Compulsive Disorders

Background: Both Bipolar Disorder (BD) and Obsessive Compulsive Disorder (OCD) are chronic psychiatric conditions, the first characterized by depressive and manic mood episodes and the latter characterized by obsessions and compulsions. The comorbidity between BD and OCD is not rare, and the presence of both conditions conveys important complications. The treatment supposes a challenge since antidepressants, first choice of treatment for OCD, carry an important risk for bipolar patients. Objective: In the present review our aim was to find evidence on Quetiapine's efficacy in the treatment of bipolar disorder with comorbid OCD. Method: We performed a literature review on the treatment options for comorbid BD and OCD, Quetiapine’s use in OCD and anxiety disorders and finally a MEDLINE search about the use of Quetiapine for this specific indication. Conclusion: The use of Quetiapine could be justified in patients with cycling OCD and in those who have shown benefit from this antipsychotic for BD and can tolerate adjunctive antidepressants. Still, clinical trials including this specific comorbid population should be performed to consider Quetiapine as part of BD-OCD patient’s treatment. Keywords: Bipolar disorder, obsessive compulsive disorder, comorbid, treatment, antipsychotic, quetiapine, SSRI.

Egyptian children with autism spectrum disorders: risk factors and comorbidity in relation to disease severity

Background Autism spectrum disorders (ASDs) represent a group of neurodevelopmental disorders characterized by impaired reciprocal socialization and communication, often accompanied with stereotyped ritualistic behavior. To date, no clear data could explain the dramatic worldwide increase in the incidence of ASD during the last two decades. It is suggested that some environmental factors besides a genetic predisposition leads to the disease. In addition, the disease is known to be associated with other psychiatric comorbidities. Aim The current study aimed to assess the incidence of psychiatric comorbidity present in those children and to relate the findings to the severity of the disease. Patients and methods The current study included 40 children (27 boys and 13 girls), with ages ranging from 3 to 11 years, and diagnosed with ASDs on the basis of the DSM-IV-TR criteria. Patients were divided to three groups according to their score on Gilliam Autism Rating Scale: mild ASD (10 cases); moderate ASD (11 cases), and severe ASD (19 cases). Data were collected through clinical psychiatric interview, Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), the Gilliam Autism Rating Scale, Vineland Adaptive Behavior Scales, and a scale for measuring family socioeconomic status for health research in Egypt. Results The present study demonstrated that 72.5% of the cases presented in families with middle socioeconomic status, which are highly educated, the majority (80%) of parents of studied cases lacked consanguinity degree, while only 20% from them had consanguinity from first degree; the vast majorities (92.5%) of the cases were not presented with family history of autism. As regards comorbidity, 90% of the cases were associated with one or more comorbid conditions and the presence of more than one comorbidity usually associated with male sex and severe type of autism, 72.5% of studied cases suffered from comorbid tics (40% occurs in severe autism), 25% of cases presented with associated attention-deficit/hyperactivity disorder, 20% of cases suffered from oppositional defiant disorder (ODD) as comorbid conditions, 37.5% of studied cases had comorbid obsessive compulsive disorder (OCD), and 5% of cases suffered from comorbid general anxiety disorder. Conclusion From the current study it was concluded that boys, high and moderate socioeconomic states, consanguinity, positive family history represented conditions that are associated with an increased risk for autism and ASDs in Egyptian population. Presence of one or more of those risk factors in children with autism is usually associated with severe type of the disease and more associated comorbidities. Determining the contribution of these risk factors may improve detection, earlier treatment, and better prevention of the disease. Comorbid tics, attention-deficit/hyperactivity disorder, ODD, and OCD are most presented among boys, whereas comorbid general anxiety disorder is more presented in girls with autism. The most occurring coincidence of comorbidity is comorbid tics and OCD, followed by comorbid OCD and ODD. Those coincidences were associated with severe autism and male sex. We suggest future studies using large samples to confirm the finding of the present work.

Effectiveness of Systematic Desensitization and Cognitive Behaviour Therapy in Reduction of Depression among Obsessive Compulsive Disorder patients-A Comparative Study

In this paper we focused on effectiveness of two treatment techniques-cognitive behavior therapy (CBT) and systematic desensitization imagination (SDI) on one of the high level co morbidity of obsessive-compulsive disorder (OCD) to mean depression among of Iranian OCD patients. A total of 38 participants was selected and then randomly assigned to two groups, where the first group received systematic desensitization imagination and the latter one cognitive behavior therapy. Both the groups were administered Beck‘s depression scale before and after the interventions. To find out the effectiveness of treatment techniques, repeated measure analysis of variance was used to compare the mean scores of the subjects in pre-post treatment. Results indicated CBT was found to be more effective than systematic desensitization technique in reducing depression. Only in behaviour domain, equal effectiveness was observed among the two selected therapy groups in reducing the depression.

Clinical Profile and Comorbidity of Obsessive-Compulsive Disorder among Children and Adolescents: A Cross-Sectional Observation in Bangladesh.

Obsessive compulsive disorder (OCD) is a common disorder characterised by persistent and unwanted intrusive thoughts, images, and urges and repetitive behaviours or mental acts and can cause pervasive impairments. In Bangladesh, the prevalence of OCD among children is 2% which is higher than in previous reporting. This study was aimed at looking into the type, frequency, and severity of symptoms of OCD and comorbidity among children and adolescents. A consecutive 60 OCD cases from a child mental health service with age range of 5–18 years were recruited and divided into below and above 12 years of age group. The assessment was carried out using standardized Bangla version of Development and Wellbeing Assessment and Children's Yale-Brown Obsessive Compulsive Scale was administered. Of the obsession, contamination was the highest followed by doubt, and of the compulsion, washing/cleaning was the highest followed by checking, repeating, and ordering rituals. More than half of the subjects had severe OCD and comorbidity was present in 58% subjects. Specific phobia, social phobia, major depressive disorder, and tic disorder were more prevalent. These symptoms and comorbidity profile can serve the baseline data for a country like Bangladesh and further large scale study would better generalize the study results.

Obsessive-Compulsive Disorder in Hospitalized Patients with Schizophrenia

Introduction:Comorbid obsessive-compulsive disorder (OCD) has been reported among patients with schizophrenia in other countries. But, the literature is not well-documented on this issue in Iran (Persia). The present study aimed to investigate the prevalence and severity of OCD and some of its related factors in a group of patients with schizophrenia in Iran.Methods:This is a cross-sectional study. A total of 150 hospitalized patients with schizophrenia were recruited at Razi Psychiatric Hospital in Tehran, Iran. Demographic and clinical checklists, as well as the Yale-Brown obsessive-compulsive scale (Y-BOCS), scale for assessment of negative symptoms (SANS), and scale for assessment of positive symptoms (SAPS) were administered to collect data. OCD was the dependent variable and independent variables included age, sex, severity of positive and negative symptoms, duration of schizophrenic disorder, the number of hospitalizations, and antipsychotic medications administered to them. Data were analyzed by analysis of variance (ANOVA), Chi-square, and T-test.Results:Overall, 31.3% of patients had OCD with an average severity of 12.81(SD=10.27). The prevalence of OCD was not affected by the number of psychiatric hospitalizations for schizophrenia or the duration of schizophrenic disorder. The severity of OCD significantly reduced as the duration of schizophrenia and the severity of negative symptoms increased.Conclusion:OCD was found among a considerable proportion of the study sample. OCD may be associated with exacerbating schizophrenic symptoms. Therefore, psychiatrists should consider the simultaneous treatment of OCD and schizophrenia. Further studies are suggested in this issue.

Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder: An Old Debate Renewed.

To the Editor, Apparent comorbidity between bipolar disorder (BD) and anxiety disorders is a common condition in psychiatry with higher prevalence rates for generalised anxiety disorder, social phobia, panic disorder.1 Overlapping clinical criteria for many diagnoses, especially mood and anxiety disorders, produced by the Diagnostic and Statistical Manual of Mental Disorders (DSM) might lay behind these high prevalence rates.2 Using DSM, it is unclear whether concomitant diagnoses actually reflect the presence of distinct clinical entities or refer to multiple manifestations of a single clinical entity. With regard to anxiety disorders, one of the most difficult additional psychiatric diagnosis to manage in BD patients is obsessive-compulsive disorder (OCD).3,4 In our recent meta-analysis, the pooled prevalence of OCD in BD was 17.0%, which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%).5 In line with previous studies,6 OCD prevalence rate was higher among BD children and adolescents (24.2%, compared to 13.5% in adults). The co-occurrence of symptoms of BD and OCD was noted 150 years ago by Morel,7 but the topic is insufficiently studied and the relationship between BD and OCD remains unclear. In agreement with Kraepelin's thought a psychiatric diagnosis is best established by its longitudinal course of illness, the evidence so far supports the view that, especially among patients with a primary diagnosis of BD, the majority of comorbid OCD cases appeared to be related to mood episodes.8 OC symptoms in comorbid patients appeared more often-and sometimes exclusively-during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes. Therefore, only a substantial minority of comorbid BD-OCD may represent OCD independent of BD with OC symptoms that improve or worsen during mood episodes without being related to these. These findings are in line with Feinsteins definition of comorbidity, as any distinct additional entity that has existed or may occur during the clinical course of a patient who has the index disease under study.2 True OCD comorbid with BD would represent the random co-occurrence of two independent diseases, estimated by multiplication of prevalence rates, which are about 1% for each condition, and producing a very low expected true comorbidity of 0.1% in the general population. The treatment of BD-OCD patients remains a great challenge, since the gold standard for one disease (serotonin reuptake inhibitors for OCD) can worsen the other (antidepressants can cause mania and/or more mood episodes in BD). The clinical features of comorbid BD-OCD patients would explain why OCD and BD symptoms respond to adequate mood stabilizer treatment.3 Only in a minority of comorbid patients with persistent OCD, despite improvement in mood episodes, addition of low doses of antidepressants could be considered while strictly monitoring emerging symptoms of mania or mixed states. Benefit with antipsychotics was also seen, although a few reports also exist of exacerbation of OC symptoms with neuroleptic agents. Considering the growing interest over the last decades into shared pathophysiologies across psychiatric disorders, studies addressing neurobiological substrates are essential to illuminate pathogenetic mechanisms that underlie comorbid BD-OCD.