Magazine article Clinical Psychiatry News

Sudden Obsessive-Compulsive Behavior? Think Group A Strep. (Small Study of Children)

Magazine article Clinical Psychiatry News

Sudden Obsessive-Compulsive Behavior? Think Group A Strep. (Small Study of Children)

Article excerpt

CHICAGO -- "I knew he had strep throat because he was acting goofy."

Most pediatricians have heard a parent say that at one time or another, and perhaps wondered what it meant. In some cases, the explanation could be a phenomenon known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or "PANDAS," Dr. Michael E. Pichichero told this newspaper during a poster presentation at the annual Interscience Conference on Antimicrobials and Chemotherapy sponsored by the American Society for Microbiology.

The phenomenon, manifesting as acute symptoms of obsessive-compulsive disorder (OCD), tics, or Tourette's syndrome, was first described in the mid-1990s. Now, Dr. Pichichero and Dr. Marie Lynd Murphy have conducted the first prospective study to confirm that PANDAS is associated with acute group A [beta]-hemolytic streptococcal (GABHS) tonsillopharyngitis and to show that it may respond to appropriate antimicrobial therapy.

It's a good idea to look at the throat of a child who presents with sudden anxiety, tics, OCD, or age-inappropriate attention-deficit hyperactivity disorder (ADHD). If the throat is red but the swab is negative, tell the parent to bring the child back in 3 days and check again, advised Dr. Pichichero, professor of pediatrics, medicine, microbiology, and immunology at the University of Rochester (N.Y.).

During 1998-2000, Dr. Pichichero and Dr. Murphy identified 12 children at Elmwood Pediatric Group who met the PANDAS criteria. Each had abrupt onset of severe obsessive-compulsive behavior, tic, age-inappropriate separation anxiety, or late-onset ADHD. In two-thirds of the cases, the parent could pinpoint the exact day the symptoms started.

As has been reported previously, males outnumbered females (seven to five). The children ranged in age from 5 to 11 years, with a mean age of 7. Onset typically occurred between September and April. All the children had obsessive thought patterns, typically related to fear of germs, illness, death, or loss of a loved one. …

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