Association of bipolar I disorder with obsessive compulsive disorder: A clinical study from Pakistan

Background: The association and/or comorbidity of bipolar I disorder I (BD I) with obsessive compulsive disorder (OCD) is discussed in the literature. This association is under-recognized in Pakistan causing management problems. This is the first study reporting this association in Pakistan.Method: Retrospective data collection of 500 patients consecutively diagnosed with BD I according to DSM IV-TR was done in inpatient and outpatient settings at a tertiary care setting in Karachi, Pakistan; 469 patients who fulfilled the criteria were included in the study. Patients with BD I with and without OCD were compared for demographics, presenting symptoms, duration of disease, differences in treatment, and other clinical variables.Results: 35 (7.5%) of the 469 patients had OCD along with BD I, with more than half having bipolar as the first diagnosis. A majority of the BD I−OCD patients had OCD symptoms during manic phase or in remission, with contamination as the main theme. The BD I−OCD group had a lower level of education, higher divorce rates, a higher incidence of OCD, as well as BD in the family, longer duration of illness, and fewer medical comorbidities.Limitations: This is a retrospective study with patients from both inpatient and outpatient settings from a tertiary care hospital.Conclusion: The association of BD I with OCD needs to be recognized by clinicians, as presentation may be different in this group especially in contextualized settings in Pakistan, where OCD or OCD-like symptoms may be related to BD itself. This finding has important diagnostic and management implications