Bipolar disorder, obsessive compulsive disorder, bipolar disorder and obsessive compulsive disorder comorbidity: Comparison of clinical features, personality and temperament

Bipolar Disorder, Obsessive Compulsive Disorder, Bipolar Disorder and Obsessive Compulsive Disorder Comorbidity: Comparison of Clinical Features, Personality and Temperament Objective: The main aim of this study was to examine patients socio-demographic characteristics, disorder characteristics and to determine the clinical course, examining the scale of the effect of comorbid disease severity, and whether if there is a connection between impulsivity and personality and temperament case with Bipolar Disorder (BPD), Obsessive Compulsive Disorder (OCD), Bipolar Disorder and Obsessive Compulsive Disorder (BPD-OCD) comorbidity. Method:The sample included 200 patients, between age 18-65, who were consecutively admitted to Adnan Menderes University Psychiatry Clinics and on the basis of DSM-IV, diagnosed BPD, OCD (with or without Major Depression-MD) and comorbid BPD and OCD. Patients with pure or comorbid diagnosis of OCD were administered Yale-Brown Obsessive Compulsive Scale (YBOCS), and patients with pure or comorbid diagnosis of BPD were administered Young Mania Rating Scale (YMRS). The cases who had 12 and over YMRS scores were not included in the Study. All participants were applied Sheehan Disability Scale (SDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS) and Beck Suicidal Ideation Scale (SSI), Barratt Impulsiveness Scale-11 (BIS-11), Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS- A) and the Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A). The current clinical status for BD patients were determined as euthymia (BDI<17; YMRS<12), major depression (BDI≥17). The YBOCS score range of severity for patients were: 0–7, sublinical; 8–15, mild; 16–23, moderate; 24–31, severe; 32–40, extreme. The course of OCD was determined chronic form in which the symptoms persisted for most of the course, causing an impairment in functioning and episodic course which was associated with a history of remission (no OCs or at least a subclinical course for 3 ≥ months) and relapse. The patients were divided into 4 groups after applying clarify the diagnosis of SCID-I. Thus, we compared BPB (n = 75), BPD-OCD (n = 40), OCD (n = 40) and the OCD-MD groups (n = 45) patients with respect to several sociodemographic and clinical variables, impulsivity, personality and temperament characteristics. Results: The subtypes of bipolar II and NOS were more common in BPD–OCD than BPD (p<0.0001). Age at onset of BD seemed to be earlier in BD–OCD group compared to pure BD patients (p=0.036). The number of psychiatric hospitalizations in both groups (p<0.001) BPD and BPD-OCD (p<0.001) were higher compared to the OCD group; in OCD-BPD was higher compared to the OCD-MD (p=0.032). Previous history of suicide attempts in the BPD group (p=0.047) and in the BPD-OCD group (p=0.004) were higher than the OCD group; BPD-OCD compared to the OCD-MD (p=0.009) were higher. The number of suicide attempts tended more likely to be higher in OCD-BPD group compared to both OCD group (p<0.001) and OCD-MD group (p=0.018). While trauma history was higher in OCD-MD group than OCD group, the sexual trauma was higher in both BPD-OCD and OCD-MD groups than OCD group. The scores of hopelessness were higher in both BPD-OCD (p=0.003) and OCD-MD (p<0.001) groups than OCD, and in OCD-MD than BPD-OCD (p=0.005). Depressive symptoms tended more likely to be higher in BPD-OCD than both OCD (p=0.001) and BPD (p=0.032) groups, on the other hand higher in OCD-MD than both OCD (p<0.001) and BPD-OCD (p<0.001). Also anxiety tended more likely to be higher in BPD-OCD than both OCD (p<0.001) and BPD (p=0.010) groups, on the other hand higher in OCD-MD than both OCD (p<0.001) and BPD-OCD (p=0.006). From the perspective of suicidal thoughts, SSI scores wer higher in BPD-OCD group than both OCD (p<0.001) and BPD (p=0.004) groups. The severity of OC symptoms were higher in OCD-MD group than BPD-OCD (p<0.001) and OCD (p=0.0013) groups; and lower in BPD-OCD group than OCD (p<0.001) group during the assessment. The frequency of episodic course tended to be higher in OCD–BD patients than in pure OCD patients, on the other hand the frequency of chronic form was higher in OCD-MD than OCD patients (p=0.017). Religious obsessions and ritualistic compulsions tended to be higher in both OCD–BD (p<0.001, p=0.002) and BPD-OCD (p=0.002, p=0.011) groups than in pure OCD patients. Non-planning impulsivity scores were lower in pure OCD gruop compared to both BPD (p=0.012), BPD-OCD (p=0.027) and OCD-MD (p=0.040) groups. Motor impulsivity scores were also lower in pure OCD gruop compared to both BPD (p=0.007), BPD-OCD (p=0.005) and OCD-MD (p=0.016) groups. Attentional impulsivity were lower in pure OCD gruop compared to both BPD-OCD (p=0.003) and OCD-MD (p=0.004) groups. Total impulsivity scores were lower in pure OCD gruop compared to both BPD (p=0.006), BPD-OCD (p=0.003) and OCD-MD (p=0.004) groups. In terms of personality profile, the Lie Scale scores tended more likely to be higher in BPD-OCD group than both BPD (p=0.035) and OCD (p=0.014) gruops; psychoticism scores tended more likely to be lower in OCD group than both BPD (p=0.017) and BPD-OCD (p=0.017) gruops, higher in BPD-OCD group than OCD-MD (p=0.013) group; neuroticism scores tended more likely to be higher in OCD-MD group than both OCD (p<0.001) and BPD-OCD (p=0.003) groups. In terms of temperament characteristics, depressive temperament scores tended more likely lower in OCD group than both BPD-OCD (p=0.039) and OCD-MD (p<0.001) groups, higher in OCD-MD group than BPD-OCD group (p=0.035). Cyclothymic temperament scores tended more likely lower in OCD group than both BPD-OCD (p=0.009) and OCD-MD (p<0.001) groups. İrritable temperament scores tended more likely higher in BPD-OCD group than both BPD (p=0.034) and OCD (p=0.006) groups, higher in OCD-MD group than OCD group (p<0.001). Anxious temperament scores tended more likely lower in OCD group than both BPD-OCD (p=0.016) and OCD-MD (p<0.001) groups, higher in OCD-MD group than BPD-OCD group (p=0.005). Conclusion: When we compared BPD and BPD-OCD groups; group the age of onset of BPD was earlier; the frequencies of BPD-II and BPD-NOS were higher; suicidal thoughts and irritable temperament scores were higher, the lie scale of personality profil were lower in BPD-OCD group than OCD group. When we compared BPD and OCD groups; number of hospitalization and previous history of suicidal attempts; psychoticism scores; non-planning, motor and total impulsivity scores were higher in BPD than OCD group. When we compared OCD and BPD-OCD groups; obsessive, compulsive and both OC symptom scores; the severity of OCs; the lie scale of personality profil were higher in OCD group than BPD-OCD group. On the other hand, the frequencies of religious obsessions and ritualistic compulsions; suicidal thoughts; total impulsivity and all subscale scores; psychoticism scores; depressive, cyclothymic, irritable and anxious temperament scores were higher in BPD-OCD group than OCD group. When we compared OCD and OCD-MD groups; obsessive, compulsive and both OC symptom scores; number of obsessions and compulsions; the severity of OCs; the frequencies of religious obsessions and ritualistic compulsions; total impulsivity and all subscale scores; neuroticism scores; depressive, cyclothymic, irritable and anxious temperament scores were higher in OCD-MD group than OCD group. When we compared BPD-OCD and OCD-MD groups; number of hospitalization and previous history and number of suicidal attempts; the frequency of episodic course of OCD; psychoticism scores were higher in BPD-OCD group than OCD-MD group; on the other hand, obsessive, compulsive and both OC symptom scores; the severity of OCs; the frequency of chronic form of OCD; neuroticism scores; depressive and anxious temperament scores were higher in OCD-MD group than BPD-OCD group. Key Words: OCD, BPD, MD, comorbidity, impulsivity, personality, temperament