Karadeniz Technical Univercity Medical Faculty, Psychiatry Department, Trabzon, Turkey.
Karadeniz Technical Univercity Medical Faculty, Psychiatry Department, Trabzon, Turkey.
Compr Psychiatry. 2019 Feb;89:61-66. doi: 10.1016/j.comppsych.2018.11.013. Epub 2018 Dec 21.
Cognitive dysfunction and immune system disorders are two actual issues for the patients with Obsessive Compulsive Disorder (OCD). The cognitive dysfunctions have been considered to substantial part of clinical phenomenon of OCD but exploration of various etiopathogenesis of cognitive dysfunction is needed. Immune dysfuncion has been implicated to be important part of pathopysiology of OCD and different lines of evidence suggests immune abnormalities in OCD. But whether these immune changes are traits of disease or secondary to clinical burden of the disease such as cognitive dysfunctions has not been determined. Data regarding relation between the cognitive dysfunctions and immune system disorders in OCD is unsatisfied. In this study we aimed to investigate the relation of blood levels of interleukin 1-beta (IL-1ß), interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) with various neurocognitive functions in patients with OCD in comparison with its autogenous/reactive subtypes and healthy controls. Further exploration of the effects of various clinical variables on cognitive functioning in patients with OCD and additional investigation of whether the cognitive dysfunction associated with this disorder differs from or overlap with that in other anxiety disorders are needed.
Forty-two patient with OCD and 45 age, sex and educational level matched healthy control were enrolled in the study. The diagnosis of OCD was made with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Yale- Brown Obsessive-Compulsive Scale, Beck Anxiety and Depression Inventory Scales were administered. Neuropsychological test battery including Wisconsin Card Sorting Test (WCST), Trail Making Test A and B (TMT-A, TMT-B) were used for evaluation of the patients and healthy control. The plasma of interleukin-1beta (IL-1ß), interleukin-6 (IL-6), Tumor Necrosis Factor-Alpha (TNF-α) of both groups were measured with ELISA kits.
Blood levels of IL-1ß, IL-6 and TNF-α were significantly higher in patients with OCD than the healthy control. There was significant difference in IL-1ß, IL-6 but not in TNF-α between autogenous/reactive subtypes and healthy controls. TNF-α is positively correlated with TMT-A, TMT-B and Stroop Test Part 5, negatively correlated with immediate memory, verbal learning, interference effect, immediate recall, delayed recall and recognition in RAVLT. IL-1ß was positively correlated with TMT-A score. IL-6 was positively correlated with scores of TMT-A, TMT-B. IL-6 was negatively correlated with immediate memory, verbal learning, interference effect, immediate recall and delayed recall in RAVLT, positively correlated with number of perseverative error and negatively correlated with the number of categories completed in WCST.
This is the first study that investigates the relation of IL- 1ß, IL-6 and TNF-α levels with cognitive functions in OCD. There may be a contribution to pathogenesis of OCD and subtypes then new choices for treatment might be developed. Moreover, uncovering the effect of cytokine blood levels on cognitive function of OCD, new data concerning etiopathogenesis and further treatment choices can be gained.
认知功能障碍和免疫系统紊乱是强迫症(OCD)患者面临的两个实际问题。认知功能障碍已被认为是 OCD 临床现象的重要组成部分,但仍需要探索各种认知功能障碍的发病机制。免疫功能紊乱被认为是 OCD 病理生理学的重要组成部分,不同的证据表明 OCD 存在免疫异常。但是,这些免疫变化是疾病的特征还是疾病的临床负担(如认知功能障碍)的次要因素尚不确定。关于 OCD 中认知功能障碍与免疫系统紊乱之间关系的数据并不令人满意。在这项研究中,我们旨在比较 OCD 患者及其自体/反应性亚型与健康对照组之间白细胞介素 1-β(IL-1β)、白细胞介素 6(IL-6)和肿瘤坏死因子-α(TNF-α)的血液水平与各种神经认知功能之间的关系。需要进一步探讨各种临床变量对 OCD 患者认知功能的影响,并进一步研究与该疾病相关的认知功能障碍是否与其他焦虑症不同或重叠。
研究纳入了 42 名 OCD 患者和 45 名年龄、性别和教育程度相匹配的健康对照组。采用精神障碍诊断与统计手册第四版(DSM-IV)的结构临床访谈对 OCD 进行诊断。采用耶鲁-布朗强迫量表、贝克焦虑和抑郁量表对患者和健康对照组进行评估。使用威斯康星卡片分类测试(WCST)、连线测试 A 和 B(TMT-A、TMT-B)等神经心理学测试套件对患者和健康对照组进行评估。采用 ELISA 试剂盒测量两组白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的血浆水平。
与健康对照组相比,强迫症患者的 IL-1β、IL-6 和 TNF-α 血液水平显著升高。自体/反应性亚型与健康对照组之间的 IL-1β、IL-6 存在显著差异,但 TNF-α 无差异。TNF-α与 TMT-A、TMT-B 和 Stroop 测试第 5 部分呈正相关,与即时记忆、词语学习、干扰效应、即时回忆、延迟回忆和 RAVLT 中的识别呈负相关。IL-1β与 TMT-A 评分呈正相关。IL-6 与 TMT-A、TMT-B 评分呈正相关。IL-6 与 RAVLT 中的即时记忆、词语学习、干扰效应、即时回忆和延迟回忆呈负相关,与 WCST 中的持续错误数呈正相关,与完成的类别数呈负相关。
这是第一项研究白细胞介素-1β、IL-6 和 TNF-α 水平与 OCD 认知功能之间关系的研究。这可能对 OCD 及其亚型的发病机制有一定的贡献,然后可能会开发出新的治疗选择。此外,揭示细胞因子血液水平对 OCD 认知功能的影响,可以获得关于发病机制和进一步治疗选择的新数据。