Some Adults with OCD Have Anti–Basal Ganglia Antibodies

Twenty percent of adults with obsessive-compulsive disorder were found to have these antibodies, compared with 4% of patients with other psychiatric disorders.

Anti–basal ganglia antibodies (ABGAs) have been found in patients with Sydenham chorea, which is a sequel of streptococcal infection (strep) and has a high comorbidity with obsessive-compulsive disorder (OCD). Following this discovery, ABGAs have been examined as potential pathogeneses for other OCD-like behaviors after strep, such as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

These researchers studied prevalence of ABGAs and titers of antistreptolysin O (ASO; a marker of strep) in 96 adults with OCD (mean age, 42; mean age at onset, 16) and in 50 controls with chronic psychiatric illness and of similar age and sex; 33 controls had unipolar depression, and 17 had schizophrenia. The three antigens studied were enolase, pyruvate kinase, and aldolase C.

Significantly more OCD patients than controls (20% vs. 4%) had ABGAs, largely to the enolase antigen. No between-group differences were found in ASO titers. There were no significant associations between ABGAs and clinical severity, symptoms, or ASO titers.

Comment: Similar to findings regarding PANDAS  the relationships of OCD to streptococcal infections, anti–basal ganglia antibodies, and clinical presentation are not straightforward. Antibiotic therapy in PANDAS patients has been studied with inconclusive results. Therefore, whether to initiate antibiotic therapy in adults with OCD and ABGAs will require weighing risks and benefits for each individual patient. Psychiatrists, however, should document strep infections and onsets and offsets of OCD symptoms because such data may be therapeutically informative as research in this area unfolds.

Published in Journal Watch Psychiatry February 27, 2012

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