Clinician Perspectives on Psychiatric and General Medical Comorbidities

As psychiatrists we must remember that comorbidities is often the rule, not the exception. This is especially true for obsessive and compulsive disorder (OCD). Not only is this important from a diagnostic point of view, but treatment may need to be pharmacologically as well as behaviorally diverse to treat all the co-existing conditions.

The articles in this Special Report address some of the more common comorbidities: bipolar disorder; Tourette syndrome; and anxiety disorders, such as panic disorder, generalized anxiety disorder, simple phobia, and specific phobia, especially in an adolescent population. In discussing bipolar disorder, the point is made that treating the mania may be enough and that adding a serotonin reuptake inhibitor could worsen mood symptoms, particularly mania. In treating Tourette syndrome, special attention should be given to Comprehensive Behavioral Intervention for tics before considering the addition of neuroleptics or the newer alpha-2 adrenergic agonist in the separate treatment of the tics in addition to the OCD.

With the article by Andrea Aguglia, MD, PhD, and colleagues, we are reminded that the brain is connected to the rest of the body. Comorbid general medical problems such as diabetes, hypertension, and obesity may be related to OCD treatment or precipitated by environmental stressors as a result of living with the disorder. Some of these environmental stressors include living lonely isolated lives and engaging in unhealthy behaviors, such as alcohol use and smoking, to deal with the anxiety related to OCD symptoms.

Pregnancy is another type of stress that cannot be overlooked as a cause or exacerbation of OCD. Erika L. Nurmi, MD, PhD, and Carol A Mathews, MD, address postpartum OCD and make some specific recommendations for treatment during and after pregnancy. In particular, they note physiological and psychodynamic issues around breastfeeding. For example, new mothers may obsess about harming the newborn from exposure in utero or in breast milk because of the OCD medications they are taking.

Meanwhile, Jon E. Grant, MD, and Samuel R. Chamberlain, MD, provide hope in what we have learned most recently about the neurobiology of OCD but also challenges for us to fill in the blanks about what we still do not know. They make note of newer regions outside of the orbital frontal loop that might be part of the neurophysiology of OCD.

Although there is still more to say and learn, together these articles provide up-to-date information that clinicians can turn to when making treatment decisions for OCD, its comorbidities and related disorders.

Disclosures:

Dr Pato is Co-Director, Institute for Genomic Health (IGH) and Professor and Vice Chair for Research, Department of Psychiatry, SUNY Downstate, Brooklyn, NY. She reports no conflicts of interest concerning the subject matter of this Special Report.