title: Vitamin D Deficiency in Obsessive-Compulsive Disorder Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: A Case Control Study.
abstract: BACKGROUND
  Previous studies have indicated that vitamin D deficiency is common in psychiatric patients, particularly in those with neuropsychiatric disorders such as autism and schizophrenia. Vitamin D is an important neurosteroid hormone and immunomodulatory agent that also has bone metabolic effects. There has been an increasing interest in immune-related neuropsychiatric symptoms that are triggered by group A beta-hemolytic streptococcal infections. In this study, we aimed to compare the serum levels of vitamin D between obsessive-compulsive disorder (OCD) patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and control subjects.
  
  
  METHODS
  Thirty-three OCD patients with PANDAS and 20 healthy controls were enrolled in the study. Serum 25-hydroxyvitamin D (25-(OH) D), calcium, phosphorus, alkaline phosphatase, and parathormone levels of the two groups were compared. Serum 25-(OH) D levels of <15 ng/mL were classified as vitamin D deficiency. The children's Yale-Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression (CGI) were used to assess the severity of OCD symptoms.
  
  
  RESULTS
  There was no significant difference in serum 25-(OH) D levels between the patient and control groups. However, vitamin D deficiency was significantly more frequent in the patient group than in the control group (48.5% vs. 20.0%; p=0.038). Moreover, OCD patients with vitamin D deficiency had higher rates of comorbid ADHD than those without vitamin D deficiency (87.5% vs. 52.6%; p=0.027). While serum phosphorus levels were negatively correlated with age as well as alkaline phosphatase and ASO levels, they were positively correlated with the YBOCS total score and global severity score. Serum parathormone levels were positively correlated with the YBOCS total score, compulsion score, obsession score, and global severity score.
  
  
  CONCLUSIONS
  This study supports the hypothesis that an association between vitamin D metabolism and PANDAS-related OCD exists. We suggest that biochemical parameters predicting metabolic bone diseases are more common in PANDAS patients. There is a need for prospective studies to show a clear association between PANDAS and bone metabolic turnover based on autoimmune mechanisms.
authors.affiliation: Department of Child and Adolescent Psychiatry, Çukurova University, School of Medicine, Adana, Turkey.
authors.forename: Gonca
authors.initials: G
authors.lastname: Çelik
authors.affiliation: Department of Rheumatology Immunology, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Didem
authors.initials: D
authors.lastname: Taş
authors.affiliation: Department of Child and Adolescent Psychiatry, Çukurova University, School of Medicine, Adana, Turkey.
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Tahiroğlu
authors.affiliation: Department of Child and Adolescent Psychiatry, Çukurova University, School of Medicine, Adana, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Avci
authors.affiliation: Department of Pediatric Endocrinology, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Bilgin
authors.initials: B
authors.lastname: Yüksel
authors.affiliation: Department of Rheumatology Immunology, Çukurova University School of Medicine, Adana, Turkey.
authors.forename: Perihan
authors.initials: P
authors.lastname: Çam
keywords: Group A beta hemolytic streptococcal Infection; obsessive–compulsive disorder; vitamin D