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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by madison88 on December 24, 2003, at 23:46:01
when i saw the title of this article i thought, wow, that is me. i was first treated for depression and OCD with Zoloft and then Paxil, but I got rather manic on those. my ocd is mostly obsessional and has become delusional at times when my mood is at either extreme. i am now on trileptal, welbutrin, and abilify and am ok i guess. anyway, i would love some feedback about the concept of cyclothymic OCD as a diagnostic entity. i am a psych student and this will probably become my thesis topic. so, anyone think this "fits" you?" should this be a diagnostic entity or should it just be left as comorbid cyclothymia/soft bipolar and OCD? here is the abstract and the article info:
Cyclothymic OCD: a distinct form?
Journal of Affective Disorders Vol 75, Issue 1, June 2003, pp1-10
Authors: Hantouche, Angst, Demonfaucon, Perugi, Lancrenon, AkiskalAbstract: Clinical research on the comorbidity of obsessive compulsive disorder (OCD) and other anxiety disorders has largely focused on depression. However in practice, resistant or severe OCD patients not infrequently suffer from a masked or hidden comorbid bipolar disorder. Method: The rate of bipolar comorbidity in OCD was systematically explored among 453 members of the French Association of patients suffering from OCD (AFTOC) as well as a psychiatric sample of OCD out-patients (n=175). As previous research by us has shown the epidemiologic and clinical sample to be similar, we combined them in the present analyses (n=628). To assess mood disorder comorbidity, we used structured self-rated questionnaires for major depression, hypomania and mania (DSM-IV criteria), self-rated Angst’s checklist of Hypomania and that for the Cyclothymic Temperament (French version developed by Akiskal and Hantouche). Results: According to DSM-IV definitions of hypomania/mania, 11% of the total combined sample was classified as bipolar (3% BP-I and 8% BP-II). When dimensionally rated, 30% obtained a cut-off score ≥10 on the Hypomania checklist and 50% were classified as cyclothymic. Comparative analyses were conducted between OCD with (n=302) versus without cyclothymia (n=272). In contrast to non-cyclothymics, the cyclothymic OCD patients were characterized by more severe OCD syndromes (higher frequencies of aggressive, impulsive, religious and sexual obsessions, compulsions of control, hoarding, repetition); more episodic course; greater rates of manic/hypomanic and major depressive episodes (with higher intensity and recurrence) associated with higher rates of suicide attempts and psychiatric admissions; and finally, a less favorable response to anti-OCD antidepressants and elevated rate of mood switching with aggressive behavior. Limitation: Hypomania and cyclothymia were not confirmed by diagnostic interview by a clinician. Conclusion: Our data extend previous research on “OCD-bipolar comorbidity” as a highly prevalent and largely under-recognized and untreated class of OCD patients. Furthermore, our data suggest that “cyclothymic OCD” could represent a distinct form of OCD. More attention should be paid to it in research and clinical practice.
Posted by Dinah on December 25, 2003, at 12:51:48
In reply to cyclothymic OCD anybody?/info on a newer article, posted by madison88 on December 24, 2003, at 23:46:01
Those are my two diagnoses, cyclothymia and OCD. But I haven't been able to pin down a correlation between the mood cycles and severity of OCD. have you noticed that there are certain moods where you have more trouble with OCD?
I *have* noticed that when I'm not really in touch with my feelings my OCD tends to flare up a lot more. And I'm almost positive (in the face of physiological evidence to the contrary, I'll admit) that OCD can be a defense mechanism against intolerable feelings. So that maybe people with mood disorders would be more likely to get OCD if they try to distance themselves from the bad feelings.
Just my own crackpot idea.
Posted by madison88 on December 25, 2003, at 17:26:20
In reply to Re: cyclothymic OCD anybody?/info on a newer article » madison88, posted by Dinah on December 25, 2003, at 12:51:48
i have read that if you have OCD and are depressed, you are more likely to become manic on antidepressants than if you are just depressed. it is because of this that there seems to be a link between OCD and bipolar disorder. i know that when i am depressed, my obsessions are darker and can become delusions. for example, i have obsessed about how little money i have when i really have enough. i have twice been convinced i was pregnant even when all the medical tests indicated otherwise. (pregnancy at this point in my life would have been a nightmare.) when my moods have been high, i have become obsessed if the way my apartment looks and have ran out and bought all kinds of crap to try and make it look better. the depressive and manic symptoms intertwine with the obsessive and produce delusions.
"I *have* noticed that when I'm not really in touch with my feelings my OCD tends to flare up a lot more"
this makes sense. it makes sense that the further you are from conscious awareness of your innner states the less able you are to regulate them. isn't OCD a condition that involves bombardments of disturbing thoughts/perceptions/etc that result in compulsions to try and rid yourself of them? so if you are not aware of your feelings, you can't possibly distinguish between "normal" sensations and those that are pathological and not at all helpful.
i am interested in what kind of OCD symptoms you have. one of the things i am wondering is if people like us with comorbid OCD and cyclothymia/soft bipolar disorder have unique symptomology or symptoms that are less likely to be found in those with only OCD or only cyclothymia. what do you think? thanks for writing!
Posted by Dinah on December 25, 2003, at 21:29:10
In reply to Re: cyclothymic OCD anybody?/info on a newer article, posted by madison88 on December 25, 2003, at 17:26:20
My OCD is of the pretty standard sort. I guess it most closely resembles "responsibility OCD".
http://www.ocdonline.com/articlephillipson2.htm
Compulsions never were as much a problem with me as obsessions.
I also rather think that my suicidal ideation and self injury urges when I'm depressed are just a different manifestation of my OCD. They have that same "feel" to them.
Posted by judy1 on December 27, 2003, at 12:16:26
In reply to Re: cyclothymic OCD anybody?/info on a newer article » madison88, posted by Dinah on December 25, 2003, at 21:29:10
that was a fascinating article, thanks for posting it. BTW, have you become hypo/and or manic on ADs? what led to your cyclothymic dx? I guess I always thought the mood changes are a result of the anxiety component of OCD, unless there is a hypomanic episode? thanks, judy
Posted by madison88 on December 27, 2003, at 17:29:46
In reply to Re: cyclothymic OCD anybody?/info on a newer article » Dinah, posted by judy1 on December 27, 2003, at 12:16:26
> that was a fascinating article, thanks for posting it. BTW, have you become hypo/and or manic on ADs? what led to your cyclothymic dx? I guess I always thought the mood changes are a result of the anxiety component of OCD, unless there is a hypomanic episode? thanks, judy
thanks for writing. my first hypomanic episode occurred when i had been on zoloft and remeron for a few weeks about three years ago. there were signs i think that i might become hypomanic on ADs but nobody noticed them at the time. looking back, when i really got into an obsession, i would not sleep; i would run a hundred miles per hour until the obsession broke. once i started on ADs, it became clear that, while the obsessions were growing less severe, my mood was not totally a result of what was going on w/ the OCD at the time. sometimes the hypomania (racing ideas, increase in energy) led to multiple obsessions all running rampant at the same time. over time, the hypomanic episodes have gone from being a few hours long to a few months long, hence the cyclothymic diagnosis comorbid to the OCD. sometimes the hypomanic episodes are manifest as nervousness, but they are clearly defined by a lot of irritability as well, a key symptom of hypomania. hope this helps.
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