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To the Editor, Psychiatric comorbidity is extremely common in bipolar disorder (BD). More than half of BD patients have an additional diagnosis, one of the most difficult to manage being obsessivecompulsive disorder (OCD). The majority of BD-OCD patients experienced the onset of OCD prior to the onset of BD and presented higher prevalence of family history for mood disorders versus non-BDOCD patients.1,2 Moreover, comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/ hypomanic episodes.3 Treating BD-OCD patients remains a great challenge. Though serotonin reuptake inhibitors (SRIs) are the first line treatment for OCD, they can induce mood instability in BD, especially if administered at high doses and maintained for a long time. We present the case of a severe BD-OCD patient who experienced complete remission with aripiprazole augmentation to mood stabilizer. The patient is a 22-year-old Caucasian unmarried woman with positive family history for major depressive disorder. From the age of 16, she had presented fear of contamination, washing and cleaning rituals that had partially impaired her functional capacity. These symptoms met Diagnostic and Statistical Manual of Mental Disorders-fifth Edition (DSM-5) criteria for OCD and were untreated for four years. No history of manic or depressive episodes was reported. At the age of 20 the obsessions and compulsions increased and she presented with depressed mood and feelings of worthPrint ISSN 1738-3684 / On-line ISSN 1976-3026 OPEN ACCESS

Bipolar Disorder and Its Comorbidities: How to Treat Since the Gold Standard for One Disease Can Worsen the Other?