The role of previous streptococcal infections in adult patients with obsessive-compulsive disorder: a research study

Abstract

Introduction: Autoimmune processes have been documented in both childhood and adulthood patients with obsessive-compulsive disorder (OCD), with the pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) representing the paradigm of this model.Given the limited information available, the present study aimed at assessing the characteristics of adult patients with OCD exposed to a previous group A β-hemolytic Streptococcus infection, together with some peripheral inflammatory biomarkers.

Materials and methods: Fifty-two subjects displaying antistreptolysin O (ASO) titer positivity were recruited from a sample of 247 adult OCD outpatients, diagnosed according to DSM-5 criteria and assessed by the Yale-Brown Obsessive-Compulsive Scale. Their clinical features were assessed and compared. The possible relationships between the different parameters were also examined.

Results: Thirty-six subjects who were on medication for OCD showed significantly lower ASO titers than the other. The neutrophil count was positively and negatively related to, respectively, the "distress associated with obsessive thoughts" item and to the patients' age. The lymphocyte count and folic acid levels were higher in 30 subjects with no perinatal insults.

Conclusions: These results seem to suggest that OCD subjects with ASO titer-positivity show a chronic inflammatory state, in spite of no symptoms or recall of bacterial infections, that might be involved in both the onset and the maintenance of OCD, with immunological alterations being related to symptom dimension to be identified. They also support the notion of possible anti-inflammatory effects of some psychotropic compounds.

Keywords: antistreptolysin O titer; autoimmunity; immune system; inflammation; obsessive-compulsive disorder; streptococcal infection.