Elsevier

Biological Psychiatry

Volume 61, Issue 3, 1 February 2007, Pages 266-272
Biological Psychiatry

Original article
Obsessive-Compulsive Spectrum Disorders and Rheumatic Fever: A Family Study

https://doi.org/10.1016/j.biopsych.2006.02.021Get rights and content

Background

Obsessive-compulsive spectrum disorders (OCSDs) are more frequent in patients with active or prior rheumatic fever (RF), suggesting that OCSD and RF may share underlying etiologic mechanisms. Our objective was to estimate the frequency of OCSD in first-degree relatives (FDRs) of RF patients and controls to determine whether there is a familial relationship between OCSD and RF.

Methods

This is a case-control family study. Of the 98 probands included in this study, 31 had RF without Sydenham’s chorea (SC) and had 131 relatives, 28 had RF with SC and had 120 relatives, and 39 were controls without RF. All probands, 87.9% of the RF FDRs and 93.7% of the control FDRs were assessed directly with structured psychiatric interviews and best-estimate diagnoses were assigned. Odds ratios of morbid risks were estimated using logistic regression by the generalized estimating equations (GEE) method and compared between groups.

Results

The rate of OCSDs was significantly higher among FDRs of RF probands than among FDRs of controls (n=37; 14.7% vs. n=10; 7.3%, i=.0279). A diagnosis of OCSDs in an RF proband was associated with a higher rate of OCSDs among FDRs when compared to control FDRs (p-GEE=.02). There was a trend for a higher rate of OCSDs among FDRs of RF probands presenting no OCSD, although the difference was not significant (p-GEE=.09).

Conclusion

The results are consistent with the hypothesis that a familial relationship exists between OCSD and RF, since an OCSD in the RF proband was found to increase the risk of OCSDs among FDRs. Additional neuroimmunological and genetic studies involving larger samples are needed to further elucidate this apparent familial relationship between RF and OCSD.

Section snippets

Sample Selection

The ethical committee of the Clinical Hospital of the University of São Paulo approved this study. All subjects and their relatives gave their informed consent before entering in the study. Case probands were recruited from an RF outpatient clinic and control probands were recruited by research assistants from an orthopedic outpatient clinic at the University of São Paulo Medical School. Probands who agreed to participate and gave permission to contact their first-degree relatives (FDRs) were

Demographic and Clinical Characteristics

Demographic and clinical characteristics of the probands and relatives are shown in Table 1, Table 2, respectively. For a more detailed description of clinical features of the probands, see Hounie et al (2004).

The RF probands were more frequently affected with OCSD than were controls (Table 1). Table 3 shows the frequency and morbid risk of each OCSD in relatives of probands with and without RF. Although the frequency of each OCSD was not different in relatives of RF and controls, when these

Discussion

This is the first family study investigating psychiatric disorders in FDRs of RF probands. The results reported herein support the hypothesis that a familial relationship exists between RF and OCSDs. The rate of OCSDs among FDRs of RF probands was significantly higher than the rate among FDRs of controls. The rate of OCSDs was highest among FDRs of RF+OCSD probands. However, the rate of OCSD was also higher among FDRs of RF probands without an OCSD, although the difference was not statistically

Conclusions

The present findings suggest a familial relationship between RF and OCSDs. If these findings are replicated, clinicians should systematically obtain information about OCSD symptoms in their RF patients and family members. Similarly, the investigation of RF might be included in the psychiatric evaluation of OCSD patients. Further neuroimmunological and genetic studies are needed in order to confirm the present findings and to elucidate the mechanisms through which RF confers a high risk of OCSD

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