Bipolarity Common in Early-Onset OCD Patients. ('Hidden Comorbidity').

PITTSBURGH -- Bipolarity is highly prevalent in children with obsessive-compulsive disorder, and in adults whose OCD began during childhood or early adolescence, Dr. F.J. Kochman said at an international conference on bipolar disorder sponsored by the Western Psychiatric Institute and Clinic.

Clinicians should be alert to this "hidden comorbidity," and exercise caution in prescribing drugs such as selective serotonin reuptae inhibitors (SSRIs), particularly in the presence of signs of cyclothymic temperament, said Dr. Kochman of EPSM Agglomeration Lilloise, SaintAndre, France.

He described findings from an epidemiologic survey of 628 patients with OCD, of whom 36 were aged 6-15 years, and 211 were adults whose disorder had begun before age 15.

It was found that 41% of the children and adolescents and 72% of the early-onset adult patients had had major depressive episodes; when screened for a history of manic or hypomanic symptoms, 13% of the total sample was classified as bipolar-most with bipolar II disorder.

Cyclothymic temperament was even more prevalent: 43% of the children and 57% of the early-onset adults scored above threshold on a self-rated questionnaire of cyclothymia, Dr. Kochman said at the conference, also sponsored by the University of Pittsburgh.

A high rate of suicidallity also characterized the group: 12% of the early-onset adults and 11% of the juveniles had made suicide attempts, he said.

Twenty percent of the early-onset adults and 14% of the young patients had been treated with mood stabilizers, and manic switches with the use of antidepressants had occurred in 40% of adults and 19% of juveniles.

Dr. Kochman also reported the results of a 2-year prospective study that followed 39 juvenile and early-onset adult bipolar patients.

Manic switches occurred in 14 of these patients during the follow-up period; 12 of these had cyclothymic temperament.

He observed that a temperament questionnaire could be a useful tool in predicting bipolar switches in OCD patients, and suggested that SSRI mono-therapy might well be avoided in cyclothymic individuals.