On 2015 Feb 08, KEVIN BLACK commented:

This is a fascinating clinical problem. The following quote may be of interest:

"[T]hree of 20 patients with both TS and OCD met criteria for bipolar disorder [53]. Given a population prevalence for bipolar disorder of <1%, the 15% prevalence here is remarkable. However, a study from Spain found that 12% of 90 consecutively examined patients with TS had either bipolar disorder or schizoaffective disorder, and an additional 21% had bipolar II disorder or cyclothymia [54]. The majority of these patients (80%) also had OCD, and many of them reported fewer tics during depressive episodes and more with manic episodes [54]. This surprising prevalence of manic illness in TS+OCD patients is probably not due to excessive symptom reporting in general, as this group reported less panic disorder or agoraphobia than the other groups [53]. Further studies of this difficult to treat subgroup are warranted. ...

"53.    Coffey BJ, Miguel EC, Biederman J, Baer L, Rauch SL, O'Sullivan RL, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis 1998; 186:201-206. ...

"54.    Berthier ML, Kulisevsky J, Campos VM. Bipolar disorder in adult patients with Tourette's syndrome: a clinical study. Biol Psychiatry 1998; 43:364-370."

-- from Black KJ, Mink JW: Neuropsychiatry of movement disorders. Curr Opin Psychiatry 1999; 12(3):313-319.

On 2015 Feb 08, KEVIN BLACK commented:

This is a fascinating clinical problem. The following quote may be of interest:

"[T]hree of 20 patients with both TS and OCD met criteria for bipolar disorder [53]. Given a population prevalence for bipolar disorder of <1%, the 15% prevalence here is remarkable. However, a study from Spain found that 12% of 90 consecutively examined patients with TS had either bipolar disorder or schizoaffective disorder, and an additional 21% had bipolar II disorder or cyclothymia [54]. The majority of these patients (80%) also had OCD, and many of them reported fewer tics during depressive episodes and more with manic episodes [54]. This surprising prevalence of manic illness in TS+OCD patients is probably not due to excessive symptom reporting in general, as this group reported less panic disorder or agoraphobia than the other groups [53]. Further studies of this difficult to treat subgroup are warranted. ...

"53.    Coffey BJ, Miguel EC, Biederman J, Baer L, Rauch SL, O'Sullivan RL, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis 1998; 186:201-206. ...

"54.    Berthier ML, Kulisevsky J, Campos VM. Bipolar disorder in adult patients with Tourette's syndrome: a clinical study. Biol Psychiatry 1998; 43:364-370."

-- from Black KJ, Mink JW: Neuropsychiatry of movement disorders. Curr Opin Psychiatry 1999; 12(3):313-319.