Citation Information :
Jyotika. A Systematic Review Article Determining the Prevalence and Causal Association of Chronic Lupus Patients Developing Obsessive Compulsive Disorder. Ind J Priv Psychiatry 2023; 17 (2):83-90.
Introduction: The incidence of neuropsychiatric lupus ranges from 25% to 75% with obsessive–compulsive disorder (OCD) being a common manifestation. The cardinal correlation and pathophysiological mechanism of OCD in chronic lupus patients is still under research. The objective of this article is to determine the prevalence and causal association of a chronic lupus patient developing OCD in its course of disease. Materials and methods: Human studies, randomized control trials, non-randomized control trials, cohort series, and cohort studies were included. This search resulted in 940 published, peer reviewed scientific articles as of March 2018. There was a repetition of the articles but yet the total was above 800 articles which were individually reviewed, thoroughly analyzed, and exquisitely interpreted. Results: The brain regions and cortico-striatal-thalamic-cortical (CSTC) circuits dysfunction with abnormalities of serotonin (5-HT), glutamate, and dopamine neurotransmitters in OCD were determined. The proposed pathophysiological hypotheses of activation of autoimmunity and inflammatory mechanism with predominant role of antibodies like anti-RP antibody, N-methyl-d-aspartate receptor antibodies, anti-phospholipid antibodies etc. and also increased proinflammatory cytokines like interleukin (IL)-6, IL-8 etc., were shown with probable heterogeneous neurological origin. This hypothesis was further strengthened by evidentiary support of neuroimaging modalities like brain magnetic resonance imaging (MRI), resting functional MRI, voxel-based morphometry, diffusion-tensor imaging, quantitative susceptibility mapping etc., which even though has provided mixed inferential data, there is consistent and repeated demonstration of structural abnormalities in basal ganglia and CSTC circuits. Conclusion: The evaluation and treatment approach would be different for the patients with only OCD and the one harboring OCD with underlying lupus. In the future, more studies involving neuroimaging and pathophysiology are recommended with similar prospects for better advancement.
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