title: Obsessive-compulsive behavior as presenting symptom of primary antiphospholipid syndrome.
abstract: OBJECTIVE
  This study aimed to improve understanding and treatment of psychiatric symptoms in antiphospholipid syndrome (APS) and to present an approach to the medical management of patients presenting with obsessive-compulsive disorder (OCD) with suspected neurovascular pathology.
  
  
  METHODS
  A 15-year-old boy presented with severe OCD of recent onset. An infarct of the caudate nucleus was identified as the initial presentation of primary APS. This case report includes a selective literature review of the neuropsychiatric correlates of APS.
  
  
  RESULTS
  The patient had OCD for 3 months with increasing symptoms resulting in admission for psychiatric reasons. After referral to the emergency department 3 weeks later, an infarct of the caudate nucleus was documented using magnetic resonance images of the brain, and APS was diagnosed based on additional laboratory findings. Anticoagulant treatment (enoxaparin and phenprocoumon) in this patient was effective in reducing obsessive-compulsive symptom severity.
  
  
  CONCLUSIONS
  OCD may present as a neuropsychiatric manifestation of APS. The present observations are consistent with a thrombotic mechanism for neurologic or psychiatric symptoms in APS. In general, routine medical workup for childhood OCD is not indicated, but a comprehensive psychiatric, medical, and family history taking and physical examination are essential, particularly if OCD is of recent onset. The role of anticoagulant therapy in neuropsychiatric manifestations of APS without the presence of a cerebral infarct requires further research.
authors.affiliation: Department of Child and Adolescent Psychiatry, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. elke.vanroie@uzleuven.be
authors.forename: Elke Van
authors.initials: EV
authors.lastname: Roie
authors.forename: Veerle
authors.initials: V
authors.lastname: Labarque
authors.forename: Marleen
authors.initials: M
authors.lastname: Renard
authors.forename: Christel
authors.initials: C
authors.lastname: Van Geet
authors.forename: Loes
authors.initials: L
authors.lastname: Gabriëls
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D002421:Caudate Nucleus / Q000473:pathology; D003937:Diagnosis, Differential; D017984:Enoxaparin / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000523:psychology*; D010644:Phenprocoumon / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D010644:Phenprocoumon