Comorbidade do transtorno bipolar em pacientes com transtorno obsessivo-compulsivo: prevalência e fatores associados.
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2018-11-29
Autores
Castro, Mariana de Souza Domingues
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Universidade Estadual Paulista (Unesp)
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Introdução: Os portadores de transtorno obsessivo-compulsivo (TOC) apresen-tam com frequência transtornos comórbidos, principalmente transtornos ansiosos e afetivos, que podem influenciar a evolução clínica do TOC, além da busca e resposta ao tratamento. Algumas pesquisas investigaram a ocorrência do transtor-no bipolar (TB) em pacientes com TOC e as características clínicas deste subgru-po de pacientes, porém não há estudos sobre este tema na América Latina. O ob-jetivo foi estimar a prevalência do TB em uma amostra clínica brasileira de paci-entes com TOC e investigar possíveis fatores sociodemográficos e clínicos asso-ciados a esta comorbidade. Método: Estudo transversal com 955 pacientes adul-tos com TOC de sete centros universitários do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo (C-TOC). Foram usados vá-rios instrumentos estruturados, incluindo a escala de Yale-Brown de sintomas obsessivo-compulsivos (Y-BOCS), a escala dimensional de sintomas obsessivo-compulsivos (DY-BOCS), os inventários de depressão e ansiedade de Beck e a Entrevista Clínica Estruturada para transtornos do eixo I do DSM-IV (SCID-I) para avaliar as comorbidades psiquiátricas. Após a análise descritiva foram feitas análises bivariadas entre possíveis fatores associados à comorbidade com TB através do teste de qui-quadrado ou teste exato de Fisher (variáveis categóricas) e o teste t de Student ou Mann-Whitney (variáveis quantitativas). Tais análises fo-ram seguidas de regressão logística para controle de confundidores. Resultados: A prevalência de TB ao longo da vida foi de 7,75% (N=74). Na regressão logísti-ca as variáveis que se mantiveram associadas à comorbidade com TB foram: transtorno de pânico com agorafobia, transtornos de controle de impulso e tenta-tivas de suicídio. Conclusão: O subgrupo de pacientes com TOC e TB comórbido apresenta algumas características clínicas indicativas de maior gravidade, inclu-indo risco de suicídio, e requer um manejo terapêutico cuidadoso para o controle e a estabilização de ambos os transtornos.
Introduction: Obsessive-compulsive disorder (OCD) patients often present comorbid disorders, mainly anxiety and affective disorders, which may influence the clinical course of OCD, as well as help-seeking behaviours and response to treatment. Some studies investigated the occurrence of bipolar disorder (BD) in patients with OCD and the clinical characteristics of this subgroup of patients, but there are no studies on this topic in Latin America. The objective was to esti-mate the prevalence of BD in a Brazilian clinical sample of OCD patients and to investigate possible sociodemographic and clinical factors associated with this comorbidity. Method: This is a cross-sectional study with 955 adult OCD patients from seven university centres of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Several structured instruments were used, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Di-mensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Beck De-pression and Anxiety inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric comorbidities. After the de-scriptive analysis, bivariate analyses were performed between possible factors associated with BD comorbidity using the chi-square test or Fisher's exact test (categorical variables) and the Student's t-test or Mann-Whitney test (quantitative variables). These analyses were followed by logistic regression to control for con-founders. Results: The lifetime prevalence of BD was 7.75% (N = 74). In the lo-gistic regression, the variables that remained associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders and suicide attempts. Conclusion: The subgroup of patients with OCD and comorbid BD has some clinical features indicative of greater severity, including suicide risk, and requires a careful therapeutic approach for the control and stabilization of both disorders.
Introduction: Obsessive-compulsive disorder (OCD) patients often present comorbid disorders, mainly anxiety and affective disorders, which may influence the clinical course of OCD, as well as help-seeking behaviours and response to treatment. Some studies investigated the occurrence of bipolar disorder (BD) in patients with OCD and the clinical characteristics of this subgroup of patients, but there are no studies on this topic in Latin America. The objective was to esti-mate the prevalence of BD in a Brazilian clinical sample of OCD patients and to investigate possible sociodemographic and clinical factors associated with this comorbidity. Method: This is a cross-sectional study with 955 adult OCD patients from seven university centres of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Several structured instruments were used, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Di-mensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Beck De-pression and Anxiety inventories, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric comorbidities. After the de-scriptive analysis, bivariate analyses were performed between possible factors associated with BD comorbidity using the chi-square test or Fisher's exact test (categorical variables) and the Student's t-test or Mann-Whitney test (quantitative variables). These analyses were followed by logistic regression to control for con-founders. Results: The lifetime prevalence of BD was 7.75% (N = 74). In the lo-gistic regression, the variables that remained associated with BD comorbidity were: panic disorder with agoraphobia, impulse control disorders and suicide attempts. Conclusion: The subgroup of patients with OCD and comorbid BD has some clinical features indicative of greater severity, including suicide risk, and requires a careful therapeutic approach for the control and stabilization of both disorders.
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transtorno obsessivo-compulsivo, transtorno bipolar, comorbidade, obsessive-compulsive disorder, bipolar disorder, comorbidity