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Could bacterial infection cause OCD?

« H E » email
posted Saturday, 1 October 2005

The Royal College of Psychiatrists

Could bacterial infection cause obsessive compulsive disorder?

Some cases of obsessive-compulsive disorder (OCD) in children may be the result of autoimmunity following bacterial streptococcal infection, according to an intriguing new study published in the October issue of the British Journal of Psychiatry.

Obsessions and compulsions commonly occur in movement disorders that follow streptococcal infection, in particular a disorder known as Sydenham's chorea. These disorders are thought to be autoimmune in origin, in that antibodies raised in response to streptococcus 'cross-react' with proteins in the basal ganglia in the brain, which are involved in movement disorders.

This study tested the hypothesis that post-streptococcal autoimmunity may have a role in OCD that occurs spontaneously, or for no known reason.

The researchers examined 50 children with OCD. All patients were assessed with a structured diagnostic interview, and their blood was analysed for the presence of anti-basal ganglia antibodies (ABGA).

The findings were compared with three control groups: one neurological group with stroke, metabolic movement disorders and encephalitis; another with uncomplicated streptococcal infections; and a third with autoimmune disorders without neurological involvement.

It was found that 42% of the OCD group had circulating anti-basal antibodies. Average ABGA levels in the OCD group were higher than in any of the control groups.

The researchers comment that this study shows that a distinct subgroup of people with OCD have antibody findings similar to those seen in the movement disorder Sydenham's chorea, suggesting that autoimmunity may have a role in the genesis and/or maintenance of some cases of OCD.

The antibody-positive patients were also more likely to have the movement disorder known as 'tics' or Tourette syndrome, further supporting a link between post-streptococcal autoimmunity and movement disorders.

The researchers consider it important to compare the findings of this study with community-based studies of OCD occurring in childhood and adulthood, and also with other psychiatric disorders.

Patients with OCD that follow bacterial infections should be investigated for streptococcal infection.

Further examination of this autoimmune subgroup may provide insight into the neurobiology of OCD, and explain whether the antibodies concerned are causing the disease.

The authors discuss that all patients with OCD should be offered that current evidence-based treatments. These are cognitive behaviour therapy and selective serotonin re-uptake inhibitors (SSRIs). Further research may reveal that alternative therapies - such as antibiotics - could be used to treat some patients with OCD who do not respond to current treatment.


Reference

Dare RC, Heyman I, Giovannoni G and Church AJ (2005)
Incidence of anti-brain antibodies in children with obsessive-compulsive disorder.
British Journal of Psychiatry, 187, 314-319.

Source...

Related APG articles:
Study finds link between OCD and other neurologic conditions and strep infection

Can You Catch OCD?

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