Role of Ketamine in Obsessive-Compulsive Disorder: A review of Literature

Abstract

OCD is a chronic neuropsychiatric disorder characterised by obsessions and/or compulsions that are ego-dystonic. It is associated with significant disability, poor quality of life and high family burden, often comparable to schizophrenia and other severe mental illnesses (Gururaj et al., 2008). The National Mental Health Survey of India (2015-2016) reported the prevalence of anxiety disorders (including PTSD and OCD) to be 2·94% in the country. With its varied aetiology, autoimmunity was initially implicated in the OCD pathophysiology in the early 1990s, with the paediatric autoimmune neuropsychiatric disorder associated with group A beta-hemolytic streptococcus (GABHS), initially named PANDAS, then renamed paediatric acute neuropsychiatric syndrome (PANS) (Swedo et al., 2012). There is a fivefold higher rate of anti-basal ganglia antibodies in both paediatric and adult OCD patients compared to controls (Pearlman et al., 2014). Studies confirmed the presence of inflammatory markers in the adult OCD brain, specifically within the cortico-striatal-thalamo-cortical regions implicated in OCD pathophysiology  (Attwells et al., 2017; Cosco et al., 2019). Raised levels of Interleukins (IL-2,4,6,10), and TNF-alpha were found in comorbidity-free OCD (Rao et al., 2015). Raposo-Lima and colleagues in 2021 found raised serum levels of Neutrophil Gelatinase Associated Lipocalin (NGAL) in OCD patients compared to healthy controls (Raposo-Lima at al., 2021).