Fw: PANDAS relation to OCD behavior

[Guest guest]

Hello everyone,

Since the topics of OCD and behavior and tics comes up so often, I

thought the following message which I am forwarding from another list,

would be of interest. I've brought this up before on the CHARGE list,

but there has not been any definitive answer yet. The PANDAS condition,

which is thought to be OCD behaviors and tics connected with a strep

infection, has been studied for many years. I asked our pediatrician to

check if Kendra had this condition to see if that is what caused the

OCD, but when she did check, she didn't feel it was related for Kendra.

It may not be, but I wouldn't be surprised if there actually is a

connection of some sort between the strep or some infection and OCD for

some people. Kendra included.

Below are a couple of e-mails from parents looking at OCD in their kids

and considering if PANDAS is connected. Then there are several studies

quoted giving further information on the topic. It brings to mind how

Martha can always tell if her daughter has an ear infection or pain, not

necessarily by the fever, but definitely by the behavior. The following

e-mails and studies are looking at similar factors for those that have

strep infections. Perhaps the strep is not treated fully, or there is

some, as yet, not understood relationship to the kinds of antibiotics

used and the behaviors, or even the need for probiotics may be a part of

the problem. The topic of strep connections to OCD has many factors and

is not yet fully understood.

Some of the treatments suggested for the condition, such as blood

exchanges, are not areas I personally wish to explore. But, finding

ways to boost the immune system so that it is not as susceptible to

infection is something that definitely interests me.

Keep reading below for the forwarded messages and studies. Some of the

behavior characteristics of what the parents are describing may look

familiar. In fact I thought of V. at one point in reading when it

mentioned urinary urgency.

Some info forwarded from another list about PANDAS and OCD.......

> ----Original Message Follows---

> Hello Everyone,

> We have been seeing Dr.Goldberg for over 2 years now we just

got

the

> ASO test back and it was a little high...233.....so we are thinking

maybe

> PANDAS ...we will retest in about a month .......I don't know much

about

> this ...but I have been reading some posts about Tic with

Pandas....what

is

> that ? Just wondering ...thanks .

>

> Hi,

>

> Any type of infection can aggravate NIDS. If your child has PANDAS on

top

> of the normal NIDS symptoms.......it's pretty hard to miss. The

symptoms

> come on fairly quickly and are pretty unique. What I've found

interesting

> is that after years of telling Dr. G. about the urinary problems that

> appeared each time we had an OCD flair.......it was finally validated

in a

> publication in 2002.

>

> This is one article that I could really relate to. Although my son's

is

> triggered by some other type of infection, his response to antibiotics

like

> Bactrim and Augmentin have been just as dramatic as described in this

> article. He already had ASD symptoms. Then at age seven (2nd grade)

he

> began the handwashing, extreme nighttime fear/rituals, irrational

terrible

> moodswings, meltdowns, panic attack meltdowns, deterioration in motor,

> handwriting, math, etc. that made it impossible to leave him at

school.

> There was also a dramatic increase in sensory problems like the sock

thing

> mentioned. (also light, sound, motion) His third grade teacher has a

lot

of

> notes about his sock complaints and all his willfull " behavioral "

problems

> and who I'm sure thought I was nuts and making excuses for what was

> happening.

> http://ajp.psychiatryonline.org/cgi/content/full/155/11/1592

>

> We've experienced pretty much every symtom during a flair. Without

the

> right antibiotic we lived an increasing nightmare from about Oct til

> sometime in Spring. Then we'd be back to the normal problems until

we'd

> have another flair in early Fall.

> Cheryl

>

> " The OCD behaviors exhibited included hand washing and preoccupation

with

> germs, but daytime urinary urgency and frequency without dysuria,

fever,

or

> incontinence were the most notable symptoms in our series (58% of

patients).

> Symptoms disappeared at night. " (Abstract below)

>

> " The children's symptom onset was acute and dramatic, typically

triggered

by

> GABHS infections at a very early age (mean=6.3 years, SD=2.7, for

tics;

> mean=7.4 years, SD=2.7, for OCD). The PANDAS clinical course was

> characterized by a relapsing-remitting symptom pattern with

significant

> psychiatric comorbidity accompanying the exacerbations; emotional

lability,

> separation anxiety, nighttime fears and bedtime rituals, cognitive

deficits,

> oppositional behaviors, and motoric hyperactivity were particularly

common " .

>

> Biol Psychiatry. 2004 Jan 1;55(1):61-8.

>

> Detecting pediatric autoimmune neuropsychiatric disorders associated

with

> streptococcus in children with obsessive-compulsive disorder and tics.

>

> TK, Sajid M, Soto O, Shapira N, Edge P, Yang M, MH,

Goodman

WK.

>

> Department of Psychiatry, University of Florida, Gainesville, Florida

> 32610-0256, USA.

>

> BACKGROUND: A subgroup of children with obsessive-compulsive and tic

> disorders are proposed to have an infectious trigger. The purpose of

this

> study was to investigate the relationship between group A

streptococcal

> titers and symptom fluctuations in children with a clinical course

> resembling that described for pediatric autoimmune neuropsychiatric

> disorders associated with streptococcus. METHODS: Twenty-five children

with

> obsessive-compulsive disorder and/or tic disorder were evaluated for

> neuropsychiatric severity and group A streptococcal antibody titers

> (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week

> intervals for > or = six consecutive evaluations (total visits=277).

> RESULTS: Children with large symptom fluctuations (n=15) were compared

with

> children without dramatic fluctuations (n=10). Co-movements of

> obsessive-compulsive/tic severity and group A streptococcal antibodies

were

> assessed. In subjects with large symptom changes, positive

correlations

were

> found between streptococcal titers and obsessive-compulsive severity

rating

> changes (p=.0130). These subjects were also more likely to have

elevated

> group A streptococcal titers during the majority of observations

(p=.001).

> Tic symptom exacerbations occurred more often in the fall/winter

months

than

> spring/summer months (p=.03). CONCLUSIONS: Patients with marked

> obsessive-compulsive/tic symptom changes may be characterized by

> streptococcal titer elevations and exhibit evidence of seasonal tic

> exacerbations.

>

> PMID: 14706426 [PubMed - in process]

>

> Arch Pediatr Adolesc Med. 2002 Apr;156(4):356-61.

>

> Prospective identification and treatment of children with pediatric

> autoimmune neuropsychiatric disorder associated with group A

streptococcal

> infection (PANDAS).

>

> ML, Pichichero ME.

>

> Elmwood Pediatric Group, University of Rochester Medical Center, 601

Elmwood

> Ave, Box 672, Rochester, NY 14642, USA.

>

> BACKGROUND: The current diagnostic criteria for pediatric autoimmune

> neuropsychiatric disorder associated with group A streptococcal

infection

> (PANDAS) are pediatric onset, neuropsychiatric disorder

> (obsessive-compulsive disorder [OCD]) and/or tic disorder; abrupt

onset

> and/or episodic course of symptoms; association with group A

beta-hemolytic

> streptococcal (GABHS) infection; and association with neurological

> abnormalities (motoric hyperactivity or adventitious movements,

including

> choreiform movements or tics). OBJECTIVE: To assess new-onset PANDAS

cases

> in relation to acute GABHS tonsillopharyngitis. DESIGN: Prospective

PANDAS

> case identification and follow-up. RESULTS: Over a 3-year period

> (1998-2000), we identified 12 school-aged children with new-onset

PANDAS.

> Each patient had the abrupt appearance of severe OCD behaviors,

accompanied

> by mild symptoms and signs of acute GABHS tonsillopharyngitis. Throat

swabs

> tested positive for GABHS by rapid antigen detection and/or were

culture

> positive. The GABHS serologic tests, when performed (n = 3), showed

very

> high antideoxyribonuclease antibody titers. Mean age at presentation

was 7

> years (age range, 5-11 years). In children treated with antibiotics

> effective in eradicating GABHS infection at the sentinel episode, OCD

> symptoms promptly disappeared. Follow-up throat cultures negative for

GABHS

> were obtained prospectively after the first PANDAS episode. Recurrence

of

> OCD symptoms was seen in 6 patients; each recurrence was associated

with

> evidence of acute GABHS infection and responded to antibiotic therapy,

> supporting the premise that these patients were not GABHS carriers.

The

OCD

> behaviors exhibited included hand washing and preoccupation with

germs,

but

> daytime urinary urgency and frequency without dysuria, fever, or

> incontinence were the most notable symptoms in our series (58% of

patients).

> Symptoms disappeared at night, and urinalysis and urine cultures were

> negative. CONCLUSION: To our knowledge, this is the first prospective

study

> to confirm that PANDAS is associated with acute GABHS

tonsillopharyngitis

> and responds to appropriate antibiotic therapy at the sentinel

episode.

>

> Publication Types:

> Case Reports

>

> PMID: 11929370 [PubMed - indexed for MEDLINE]

> Am J Psychiatry. 1998 Feb;155(2):264-71. Related Articles, Links

>

>

> Erratum in:

> Am J Psychiatry 1998 Apr;155(4):578.

>

> Comment in:

> Am J Psychiatry. 2002 Feb;159(2):320.

>

> Pediatric autoimmune neuropsychiatric disorders associated with

> streptococcal infections: clinical description of the first 50 cases.

>

> Swedo SE, Leonard HL, Garvey M, Mittleman B, AJ, Perlmutter S,

Lougee

> L, Dow S, Zamkoff J, Dubbert BK.

>

> Section on Behavioral Pediatrics, NIMH, Rockville Pike, Bethesda, MD

> 20892-1381, USA. swedos@...

>

> OBJECTIVE: The purpose of this study was to describe the clinical

> characteristics of a novel group of patients with obsessive-compulsive

> disorder (OCD) and tic disorders, designated as pediatric autoimmune

> neuropsychiatric disorders associated with streptococcal (group A

> beta-hemolytic streptococcal [GABHS]) infections (PANDAS). METHOD: The

> authors conducted a systematic clinical evaluation of 50 children who

met

> all of the following five working diagnostic criteria: presence of OCD

> and/or a tic disorder, prepubertal symptom onset, episodic course of

symptom

> severity, association with GABHS infections, and association with

> neurological abnormalities. RESULTS: The children's symptom onset was

acute

> and dramatic, typically triggered by GABHS infections at a very early

age

> (mean = 6.3 years, SD = 2.7, for tics; mean = 7.4 years, SD = 2.7, for

OCD).

> The PANDAS clinical course was characterized by a relapsing-remitting

> symptom pattern with significant psychiatric comorbidity accompanying

the

> exacerbations; emotional lability, separation anxiety, nighttime fears

and

> bedtime rituals, cognitive deficits, oppositional behaviors, and

motoric

> hyperactivity were particularly common. Symptom onset was triggered by

GABHS

> infection for 22 (44%) of the children and by pharyngitis (no throat

culture

> obtained) for 14 others (28%). Among the 50 children; there were 144

> separate episodes of symptom exacerbation; 45 (31%) were associated

with

> documented GABHS infection, 60 (42%) with symptoms of pharyngitis or

upper

> respiratory infection (no throat culture obtained), and six (4%) with

GABHS

> exposure. CONCLUSIONS: The working diagnostic criteria appear to

accurately

> characterize a homogeneous patient group in which symptom

exacerbations

are

> triggered by GABHS infections. The identification of such a subgroup

will

> allow for testing of models of pathogenesis, as well as the

development of

> novel treatment and prevention strategies.

>

> PMID: 9464208 [PubMed - indexed for MEDLINE]

>

>

http://ajp.psychiatryonline.org/cgi/content/full/155/2/264?ijkey=f7c9d21

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