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Impact of obsessive-compulsive disorder on the antimanic response to olanzapine therapy in youth with bipolar disorder

Authors

  • Gagan Joshi,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
    2. Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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  • Eric Mick,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
    2. Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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  • Janet Wozniak,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
    2. Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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  • Daniel Geller,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
    2. Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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  • Jennifer Park,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
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  • Samara Strauss,

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
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  • Joseph Biederman

    1. Pediatric Psychopharmacology Research Program, Massachusetts General Hospital, Boston
    2. Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
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  • Disclosure information for all authors is listed before the references.

Corresponding author:
Gagan Joshi, M.D.
Pediatric Psychopharmacology Research Program
Massachusetts General Hospital
YAW 6900, 55 Fruit Street
Boston, MA 02114, USA
Fax: (617) 724-3742
E-mail: joshi.gagan@mgh.harvard.edu

Abstract

Joshi G, Mick E, Wozniak J, Geller D, Park J, Strauss S, Biederman J. Impact of obsessive-compulsive disorder on the antimanic response to olanzapine therapy in youth with bipolar disorder.
Bipolar Disord 2010: 12: 196–204. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.

Objective:  To compare antimanic response to olanzapine therapy in youth with bipolar disorder (BPD) based on the status of comorbidity with obsessive-compulsive disorder (OCD).

Methods:  Secondary analysis of identically designed 8-week open-label trials of olanzapine therapy in youth with BPD. Severity of mania assessed with the Young Mania Rating Scale (YMRS) and Clinical Global Impression (CGI) scales.

Results:  Of the 52 BPD subjects (mean age 8.4 ± 3.1 years) enrolled in the olanzapine trials (mean dose 8.5 ± 4.3 mg/day), 39% (n = 20) met criteria for comorbid OCD. Antimanic response in BPD subjects was significantly worse in the presence of comorbid OCD (YMRS mean reduction:  −5.9 ± 13.1 versus  −13.7 ± 18.8, p = 0.04; ≥ 30% reduction: 25% versus 63%, p = 0.008; CGI-Improvement score ≤ 2: 25% versus 68%, p = 0.003). There was no difference in the rate of dropouts (50% versus 29%, p = 0.2) or adverse effects in BPD subjects with or without comorbid OCD.

Conclusions:  Less than expected antimanic response to olanzapine therapy in the presence of comorbidity with OCD suggests that OCD is an important functionally impairing psychiatric comorbidity that may impact the efficacy of antimanic agents in youth with BPD. This study is limited by its design of secondary analysis of data from trials of an uncontrolled nature. Further prospective controlled trials are warranted.

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