1 - Pedopsiquiatria, Unidade de Pedopsiquiatria, Hospital Dona Estefânia, ULS São José
2 - Pedopsiquiatria, Unidade de Pedopsiquiatria, ULS de Santa Maria
- publicação em versão integral na revista SVOA Paediatrics
Resumo:
Introduction: Comorbidity between obsessive-compulsive disorder and bipolar disorder has been a well-documented phenomenon in the adult population for several decades. However, scant evidence exists regarding this comorbidity in the juvenile population.
Objectives: The objective of this review is to investigate the impact of obsessive-compulsive disorder and bipolar disorder comorbidity on the clinical course and therapeutic approaches for each disorder individually, with a particular focus on children and adolescents.
Methods: A scientific review was conducted on a careful analysis of the evidence available on the electronic databases: MEDLINE, Embase and Cochrane Library.
Results: In children, it has been observed that up to one-third of individuals diagnosed with either obsessive-compulsive disorder or bipolar disorder also experience a lifetime co-occurrence of the other disorder, a notably higher prevalence when compared to adults. The primary diagnosis typically manifests with an earlier onset in this population. When bipolar disorder is present, children and adolescents with obsessive-compulsive disorder tend to exhibit an episodic course, more hoarding or saving obsessions and compulsions, and a significantly higher number of comorbidities. In this age group, obsessive-compulsive disorder and bipolar disorder comorbidity is further linked to increased severity symptoms, greater impulsivity, reduced responsiveness to pharmacological treatment, elevated suicide risk, and a diminished likelihood of achieving remission rates for manic and depressive symptoms. Obsessive-compulsive symptoms during childhood and adolescence may indicate vulnerability to have bipolar disorder, suggesting partially shared etiopathogenetic mechanisms between these psychiatric entities. The use of antidepressants poses a risk of inducing a switch to mania or rapid cycling in bipolar patients. Additionally, atypical antipsychotics have been reported to trigger and worsen obsessive-compulsive symptoms.
Conclusions: The complexity involved in deciding on a suitable treatment scheme for individuals with this comorbidity may contribute to an unfavorable clinical course. A noteworthy portion of comorbid patients may require a combination of multiple mood stabilizers for effective management.
Palavras Chave: Adolescents, Bipolar Disorder, Children, Manic Symptoms, Obsessive-Compulsive Disorder