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OCD

Obsessive Compulsive Disorder associated with Autoimmunity in Youth: Clinical Course before and after Rituximab+/- Adjunctive Immunomodulation
Frankovich J, Calaprice D, Ma M, Knight O, Miles K, Manko C, Hernandez JD, Sandberg J, Farhadian B, Xie Y, Silverman M, Madan J, Strand V, Chang K, Thienemann M. Obsessive Compulsive Disorder associated with Autoimmunity in Youth: Clinical Course before and after Rituximab+/- Adjunctive Immunomodulation. Dev Neurosci. 2025 Mar 10:1-26. doi: 10.1159/000544993. Epub ahead of print. PMID: 40064151.
  • Case review (n=23) from Stanford on their use of rituximab for presumed-neuroimmune and severe OCD in youth
  • Some (47.8%) experienced transient increases in psychiatric or joint pain symptoms before signs of improvement. The time frame for signs of improvement was 3-4 months. 
  • 70% achieved full or partial recovery at 1-5 years.
  • Receiving adjunct immunomodulation was associated with a higher likelihood of achieving full or partial recovery compared with those without adjunct immunomodulation
Obsessive Compulsive Disorder and Other Specified Anxiety Disorder in an 8-Year-Old Post-respiratory Infection: A Case Report

Tran, Michael; Amador, Alcides; and Camacho Bermudez, Sofia, “Obsessive Compulsive Disorder and Other Specified Anxiety Disorder in an 8-Year-Old Post-respiratory Infection: A Case Report” (2024). Research Colloquium. 91.https://scholarworks.utrgv.edu/colloquium/2024/posters/91

Conclusions: This case underscores the importance of considering infectious etiologies in the differential diagnosis of sudden-onset psychiatric symptoms in pediatric patients. The positive response to Sertraline and the proposed CBT highlights the potential benefits of a combined pharmacological and therapeutic approach in managing OCD and anxiety disorders. Continued follow-up and treatment adaptation is essential to ensure sustained improvement and quality of life for pediatric patients with similar presentations.

A population-based multigenerational family co-aggregation study of severe infections and obsessive-compulsive disorder

Pol-Fuster J., Fernández de la Cruz L., Beucke J., Hesselmark E., Crowley J.J., de Schipper E., Brikell I., Chang Z., D’Onofrio B.M., Larsson H., Lichtenstein P., Kuja-Halkola, R. & Mataix-Cols D., A population-based multigenerational family co-aggregation study of severe infections and obsessive-compulsive disorder, Biological Psychiatry (2024), doi: https://doi.org/10.1016/ j.biopsych.2024.09.004.

This large population-based study in Sweden investigated the potential link between severe infections and obsessive-compulsive disorder (OCD) through a familial co-aggregation approach. By analyzing data from over 4.9 million individuals born between 1960 and 2008, researchers explored the risk of OCD among relatives of those with severe infections, spanning varying degrees of genetic relatedness. The study found that the risk of OCD increased with closer genetic ties, with monozygotic twins showing the highest correlation. A dose-response relationship between the number of infections and the odds of OCD was also identified. These findings remained robust even after adjusting for comorbid autoimmune disorders and infections in relatives. The results suggest that genetic factors play a significant role in the observed association, pointing to shared genetic susceptibilities between infections and OCD. This supports the idea that genetic pleiotropy—where the same genes influence multiple traits—may contribute to both infection susceptibility and OCD risk. The study highlights the importance of considering both genetic and environmental factors in understanding OCD development.

Cortical glutamate and GABA are related to compulsive behaviour in individuals with obsessive compulsive disorder and healthy controls

Biria, M., Banca, P., Healy, M.P. et al. Cortical glutamate and GABA are related to compulsive behaviour in individuals with obsessive compulsive disorder and healthy controls. Nat Commun 14, 3324 (2023). https://doi.org/10.1038/s41467-023-38695-z

A Cambridge neuroimaging study found that compulsive behavior is associated with glutamate–GABA imbalance, particularly elevated glutamate, across both individuals with OCD and healthy controls. Using ultra–high field MRS, the authors show that compulsivity maps to excitatory–inhibitory imbalance in brain regions involved in habit formation and control. These findings support a mechanism-based view of compulsive symptoms, while underscoring the need for caution when targeting glutamatergic systems clinically due to their broader downstream effects. The findings are particularly relevant given increasing clinical interest in glutamate-modulating medications, which are sometimes used off-label in OCD and neuroimmune conditions. At the same time, the study reinforces the need for caution: altering glutamatergic systems can have complex downstream effects, especially in conditions where dopamine and immune signaling may also be involved. This work strengthens the rationale for mechanism-focused research while underscoring why individualized, carefully monitored treatment remains essential.

PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein–Barr Virus Reactivation as Trigger Agents?
Pallanti S, Di Ponzio M. PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein-Barr Virus Reactivation as Trigger Agents? Children (Basel). 2023 Mar 30;10(4):648. doi: 10.3390/children10040648. PMID: 37189896; PMCID: PMC10136983.
  • COVID-19 infection and pandemic-related stressors were associated with worsening neuropsychiatric symptoms in children and adolescents with PANS
  • Obsessions, tics, anxiety, mood symptoms, and overall wellbeing were most commonly affected
  • New symptoms and new-onset PANS cases were reported following SARS-CoV-2 infection
  • Case series of five adolescents showed symptom exacerbation after COVID-19 infection
  • Authors hypothesize roles for neuroinflammation, immune activation, viral reactivation (e.g., EBV), and social isolation–related inflammatory effects
  • PANS is presented as a model for understanding immune-mediated neuropsychiatric post-acute COVID syndromes (PACS)
Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study

Raposo-Lima, C., Pereira, I.M., Marques, F. et al. Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study. BMC Psychiatry 21, 272 (2021). DOI: 10.1186/s12888-021-03289-w

“Although PANDAS might be of relevance for only a minor proportion of OCD cases, this immune/inflammation hypothesis may be significant given the prevalence of OCS among patients with autoimmune diseases [9]…. In conclusion, we herein report differences in NGAL levels among OCD patients compared to healthy controls. We offer additional evidence to the immune dysregulation hypothesis of OCD by reporting elevated levels of NGAL among OCD patients versus healthy controls, with higher differences being found among women”