Mom, My Throat Hurts
A Link Found Between Strep Infection and Obsessive-Compulsive Disorder in Children

Children tend to manifest illnesses in particular ways. Some always get ear infections, others develop croup, and still others tend to get strep throat repeatedly. Scientists have found that some obsessive-compulsive disorders (OCD) and tic disorders may be set off by the same infectious bacteria that cause strep throat.

While it is rare for children to develop OCD from strep, one in 1,000 children may develop OCD-related problems following a strep infection. The good news is that the infection itself can be treated successfully with antibiotics. Time, however, is an important factor in treatment. In children who do not exhibit a sore throat or fever with a strep infection, a sudden onset of OCD symptoms and /or tics should alert parents and doctors to the possibility of a hidden strep infection and the need for antibiotics.

Many pediatricians are still unfamiliar with the connection between strep and sudden-onset OCD. This association, discovered over a decade ago, is called PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection. Susan Swedo, MD, a member of the ADAA Scientific Advisory Board, helped discover the syndrome and heads the National Institute of Mental Health PANDAS research team. According to Dr. Swedo, about 1 in 10 young children with OCD fits the PANDAS criteria. These criteria are characterized by sudden, dramatic symptom onset and relapsing-remitting episodes, in which the child may be completely symptom-free one day, and unable to attend school the next day because of washing and repeating compulsions. Rapid diagnosis is helpful, because some children will improve after antibiotics treatment of the strep throat. Others are helped by the standard treatments for OCD, which generally involve serotonin-reuptake blocking medications and cognitive behavior therapy.

The relationship between strep infection and OCD is not the only one that connects mental disorders with physical causes. Advanced syphilis and lyme disease have both been linked to psychiatric syndromes, while strep is also thought to be possibly related to anorexia.

Frequently Asked Questions About PANDAS
(Reprinted with permission from NIMH)

Q. My child has had strep throat before, and he has tics and/or OCD. Does that mean he has PANDAS?
A. No. Many children have OCD and/or tics, and almost all school aged children get strep throat at some point in their lives. Only when a child has a very episodic course of tics and/or OCD and seems to have strep throat shortly before or at the time of a dramatic worsening of symptoms does this indicate the possibility of PANDAS.
Q. Could an adult or teenager have PANDAS?
A. No. By definition, PANDAS is a pediatric disorder. It is possible that adolescents and adults may have immune mediated OCD, but this is not known. The research studies at the NIMH are restricted to PANDAS.
Q. Will Penicillin treat PANDAS?
A. No. Penicillin and other antibiotics kill streptococcus and other types of bacteria. The antibiotics treat the sore throat or pharyngitis caused by the strep., by getting rid of the bacteria. However, in PANDAS, it appears that antibodies produced by the body in response to the strep. infection are the cause of the problem, not the bacteria themselves. Therefore one could not expect antibiotics such as penicillin to treat the symptoms of PANDAS.

Additional Resources on the Link between Strep Infection and OCD

Other resources used for this article include:
http://www.brown.edu/Administration/News_Bureau/1996-97/96-084.html
http://msnbc.msn.com/id/3540627
PA-TSA News, April 2004 - Volume 22 Issue 1