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Immunological causes of obsessive-compulsive disorder: is it time for the concept of an "autoimmune OCD" subtype?
Univ Freiburg, Med Ctr, Fac Med, Dept Psychiat & Psychotherapy,Sect Expt Neuropsyc, Freiburg, Germany.;Univ Freiburg, Med Ctr, Fac Med, Dept Psychiat & Psychotherapy, Freiburg, Germany..
Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychosis Studies, London, England..
Ulm Univ, Dept Psychiat & Psychotherapy 2, Bezirkskrankenhaus Gunzburg, Gunzburg, Germany..ORCID iD: 0000-0003-4371-2932
Univ Freiburg, Med Ctr, Fac Med, Dept Psychiat & Psychotherapy, Freiburg, Germany..
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2022 (English)In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 12, no 1, article id 5Article, review/survey (Refereed) Published
Abstract [en]

Obsessive-compulsive disorder (OCD) is a highly disabling mental illness that can be divided into frequent primary and rarer organic secondary forms. Its association with secondary autoimmune triggers was introduced through the discovery of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute onset Neuropsychiatric Syndrome (PANS). Autoimmune encephalitis and systemic autoimmune diseases or other autoimmune brain diseases, such as multiple sclerosis, have also been reported to sometimes present with obsessive-compulsive symptoms (OCS). Subgroups of patients with OCD show elevated proinflammatory cytokines and autoantibodies against targets that include the basal ganglia. In this conceptual review paper, the clinical manifestations, pathophysiological considerations, diagnostic investigations, and treatment approaches of immune-related secondary OCD are summarized. The novel concept of "autoimmune OCD" is proposed for a small subgroup of OCD patients, and clinical signs based on the PANDAS/PANS criteria and from recent experience with autoimmune encephalitis and autoimmune psychosis are suggested. Red flag signs for "autoimmune OCD" could include (sub)acute onset, unusual age of onset, atypical presentation of OCS with neuropsychiatric features (e.g., disproportionate cognitive deficits) or accompanying neurological symptoms (e.g., movement disorders), autonomic dysfunction, treatment resistance, associations of symptom onset with infections such as group A streptococcus, comorbid autoimmune diseases or malignancies. Clinical investigations may also reveal alterations such as increased levels of anti-basal ganglia or dopamine receptor antibodies or inflammatory changes in the basal ganglia in neuroimaging. Based on these red flag signs, the criteria for a possible, probable, and definite autoimmune OCD subtype are proposed.

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Springer Nature Springer Nature, 2022. Vol. 12, no 1, article id 5
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Psychiatry
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URN: urn:nbn:se:uu:diva-465867DOI: 10.1038/s41398-021-01700-4ISI: 000740973300007PubMedID: 35013105OAI: oai:DiVA.org:uu-465867DiVA, id: diva2:1630795
Available from: 2022-01-21 Created: 2022-01-21 Last updated: 2024-01-17Bibliographically approved

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