Endres, D., Pollak, T.A., Bechter, K. et al. Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype?. Transl Psychiatry 12, 5 (2022). https://doi.org/10.1038/s41398-021-01700-4
Conclusion: There is increasing evidence for secondary immune-mediated forms of OCD. The DSM-5 and novel ICD-11 criteria include the category of secondary OCD, without, however, providing guidelines according to which such a diagnosis should be established. In the current paper, the authors have drafted a first proposal of clinical criteria for the definition of secondary autoimmune OCD. Future studies should investigate the prevalence (e.g., by analyzing the rate of neuronal antibodies in patients with OCD), diagnostic regimes (combination and comparison of different diagnostic methods), and optimal therapy of autoimmune OCD, including the development of clear treatment algorithms and clinical guidelines. Recognizing the autoimmune causes of OCD could inform additional therapeutic options for the affected patients to promote treatment response and reduce chronicity.
Pathophysiologically, the following subtypes should currently be distinguished:
- 1. OCD with PANDAS/PANS,
- 2. OCD with neuronal antibodies: a. against well-characterized cell surface antigens (such as NMDA-R), b. against well-characterized paraneoplastic, intracellular antigens (such as Ma2), and c. against non-well-characterized and novel neuronal autoantibodies,
- 3. OCD in the context of systemic autoimmune diseases with potential brain involvement (such as systematic lupus erythematosus),
- 4. OCD in the context of established autoimmune CNS disorders (such as multiple sclerosis).