Ziprasidone in the treatment of bipolar disorder with comorbid obsessive-compulsive disorder and gambling disorder.

Bipolar disorder (BD) is a common mental disorder, with approximately 2.4% lifetime prevalence in the general population. In addition, the co-occurrence of other psychiatric disorders with BD is very high, with as many as 65% to 95% meeting the diagnostic criteria for comorbid conditions(1). Of these, about 25% are comorbid with obsessive-compulsive disorder (OCD), and 10.6% with gambling disorder (GD) (2). Moreover, BD patients with OCD are more likely to be comorbid with impulse-control disorder, including GD, than those without OCD. Comorbid OCD in BD is associated with younger age of onset, greater risk of suicide, rapid cycling (3) or more progressively depressive episodes, more severe impairment in social function, and poorer response to treatment, including pharmacologic (hypo) manic switch, lower lithium responsiveness, and exacerbation of OCD symptoms by neuroleptic agents. Therefore, if BD with comorbid OCD further co-occurs with GD, it inevitably adds to the complexity and difficulty in treating BD. Previous systematic reviews show that treatment of BD and comorbid OCD or GD remains a challenge, since few evidence-based treatment options are available. Recently, risperidone, quetiapine, olanzapine, and aripiprazole have been reported to be effective in the treatment of BD with OCD as an add-on therapy (4), suggesting atypical antipsychotics might play a role in the treatment of BD with comorbid OCD. However, no study has ever reported that atypical antipsychotics might be effective in the treatment of BD with GD. A study even claimed that aripiprazole might be a risk factor of GD. More importantly, few studies have explored the treatment of BD with comorbid OCD and GD. Therefore, here we introduce a case of BD with comorbid OCD and GD, who was successfully treated with ziprasidone. These data contribute to the knowledge concerning available treatment options for these kinds of patients.