1 - ULS São Jose, Child and Adolescent Psychiatry and Mental Health, Lisbon, Portugal;
2 - ULS Lisboa Ocidental, Child and Adolescent Psychiatry and Mental Health, Lisbon, Portugal;
3 - ULS Santa Maria, Child and Adolescent Psychiatry and Mental Health, Lisbon, Portugal;
4 - ULS Amadora/Sintra, Child and Adolescent Psychiatry and Mental Health, Lisbon, Portugal
- Poster em Congresso Internacional – ECNP - Milão, Itália
- Abstract publicado em revista - P3051 -NEUROSCIENCE APPLIED 3 (2024) 104907
Resumo:
Background: The comorbidity between Bipolar Disorder (BD) and Obsessive- Compulsive Disorder (OCD) has been increasingly known and studied. This diagnostic overlap is not a rare finding and has more recently been the subject of considerable scientific investigation. Research found a prevalence of 17.00% OCD in adults previously diagnosed with BD and a prevalence of 18.35% BD in adults previously diagnosed with OCD. In comorbidity, the clinical expression of these entities differs in clinical severity, temporal pattern of symptoms, course of disease and prognosis from the clinical expression of each one of them when presented separately. Contrary to adulthood, where there are already various scientific publications in this area, with several cases reported, in childhood and adolescence the literature is much scarcer. In this work, the case of an adolescent with BD-OCD comorbidity is portrayed and a non-systematic review of the literature on these pathologies is carried out.
Case report: A 15-year-old female adolescent presented initially to the mental health services with depressive symptoms (depressed mood and irritability, anhedonia, intermediate and terminal insomnia, emotional lability, obsessive doubting, social isolation and school refusal) with a course of 1-year evolution and with significant deterioration in the later 4 months. Following the most likely diagnosis of Major Depressive Disorder, she started pharmacological treatment with 50mg of Sertraline 1id, 50mg of XR Quetiapine 1id and 25mg of Chlorpromazine on demand when severely distressed. In the following appointments, she shared intrusive and ego dystonic thoughts on sexualised content in which she would sexually abuse people that she came across. With maintenance of the antidepressant therapy, a few weeks later she began to feel more energetic and happened to become less socially withdrawn, although more labile and irritable in association with terminal insomnia and without daytime tiredness. She also reported growing impatience and restlessness as well as always having lots of plans. She later began engaging in risky sexual behaviour and using psychoactive substances. The diagnoses of BPD and of OCD were established in comorbidity.
Conclusions: The BD-OCD comorbidity cases are characterised by a heterotypic presentation of symptoms with added challenges for their conceptualisation and subsequent treatment. Additionally, the adolescence is a very particular period of the human development, which is naturally marked by turbulence, experimentation and typical fluctuations. Therefore, establishing the psychiatric diagnoses of mood disorders can be challenging. With the emergence of hypomanic symptoms, there arises a certain doubt as to what constitutes normative adolescence versus pathology. This threshold is delicate, making the diagnosis process difficult, especially in the absence of clear manic periods. Moreover, the type II BD appears to be more common in patients with BD-OC comorbidity compared to patients solely diagnosed with BD and the OCD comorbidity seems to be increasingly viewed as integrated in the underlying BD.
Palavras Chave: Adolescence; Bipolar disorder; Comorbidity; Obsessivo compulsive disorder