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A total-population multigenerational family clustering study of autoimmune diseases in obsessive–compulsive disorder and Tourette’s/chronic tic disorders


The association between obsessive–compulsive disorder (OCD) and Tourette’s/chronic tic disorders (TD/CTD) with autoimmune diseases (ADs) is uncertain. In this nationwide study, we sought to clarify the patterns of comorbidity and familial clustering of a broad range of ADs in individuals with OCD, individuals with TD/CTD and their biological relatives. From a birth cohort of 7 465 455 individuals born in Sweden between 1940 and 2007, we identified 30 082 OCD and 7279 TD/CTD cases in the National Patient Register and followed them up to 31 December 2013. The risk of 40 ADs was evaluated in individuals with OCD, individuals with TD/CTD and their first- (siblings, mothers, fathers), second- (half siblings) and third-degree (cousins) relatives, compared with population controls. Individuals with OCD and TD/CTD had increased comorbidity with any AD (43% and 36%, respectively) and many individual ADs. The risk of any AD and several individual ADs was consistently higher among first-degree relatives than among second- and third-degree relatives of OCD and TD/CTD probands. The risk of ADs was very similar in mothers, fathers and siblings of OCD probands, whereas it tended to be higher in mothers and fathers of TD/CTD probands (compared with siblings). The results suggest a familial link between ADs in general (that is, not limited to Streptococcus-related conditions) and both OCD and TD/CTD. Additional mother-specific factors, such as the placental transmission of antibodies, cannot be fully ruled out, particularly in TD/CTD.

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We are grateful to Daniel S Tylee and Stephen J Glatt (Psychiatric Genetic Epidemiology & Neurobiology Laboratory; Departments of Psychiatry and Behavioral Sciences & Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA) for sharing their unpublished data. The study was partly supported by a grant from the Tourette Association of America (DM-C). EF was supported by the Swedish Brain Foundation. APV was supported by a grant from the Alicia Koplowitz Foundation. LFdlC is supported by a Junior Researcher grant from the Swedish Research Council for Health, Working Life and Welfare (FORTE Grant Number 2015-00569). JJC was supported by NIMH Grants R01MH105500 and R01MH110427. CR was supported by a grant from the Swedish Research Council (K2013-61P-22168). We also acknowledge financial support from the Swedish Research Council through the SIMSAM (Swedish Initiative for Research on Microdata in the Social And Medical Sciences) framework Grant No. 340-2013-5867. PL is supported by grants from the Swedish Research Council for Health, Working Life and Welfare and the Swedish Research Council. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decisions to submit the manuscript for publication.

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Conflict of Interest

DM-C and LFdlC receive royalties for contributing articles to UpToDate, Wolters Kluwer Health. PL has served as a speaker for Medice. JFL has received support from the NIH (salary and research), the Tourette Association of America, Grifolis, LLC, and he receives book royalties from John Wiley and Sons, McGraw-Hill and Oxford University Press. HL has served as a speaker for Eli-Lilly and Shire and has received a research grant from Shire Pharmaceuticals (all outside the submitted work). The remaining authors declare no conflicts of interest.

Correspondence to D Mataix-Cols.

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