Although rare, some forms of childhood obsessive-compulsive disorder can be caused by streptococcus bacterial infection (e.g. strep throat). This form of OCD is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections otherwise known as PANDAS.
PANDAS is diagnosed clinically after a child abruptly develops several behavioral and physical symptoms following a streptococcal infection.
PANDAS is associated to an autoimmune response to a streptococcal infection. Streptococcus is linked with numerous immune-related problems such as scarlet fever, rheumatic fever, and acute glomerulonephritis.
Streptococcus bacteria hide from the host’s immune system by copying host cells. Ultimately, the immune system identifies the foreign cells and the antibodies produced attack the bacteria. However, some of the host’s own cells are also attacked because of cross-reactivity.
In some cases, these antibodies attack brain cells, thus causing tics, OCD and other symptoms observed in children with PANDAS.
Signs and symptoms
The symptoms of PANDAS are similar to attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and tics. Symptoms may occur unexpectedly.
PANDAS is clinically diagnosed. This means that it depends more on history and physical examination rather than on lab tests.
There are five accepted diagnostic criteria used by clinicians when diagnosing PANDAS.. At present, these five criteria are the only indicators of whether a child has PANDAS or not. The five diagnostic criteria include:
- Presence of oppositional behaviors, ADHD symptoms, OCD and/or a tic disorder
- Onset of symptoms from age 3 to puberty
- Sudden onset and/or symptoms differ in intensity
- Association with neurological abnormalities (motor hyperactivity, or adventitious movements, such as choreiform movements), neuropsychiatric symptoms, including bedwetting, anxiety, personality changes, emotional incontinence, decline in math skills and handwriting abilities
- Evidence of group A beta-hemolytic streptococcal infection (the bacteria that causes strep throat) through laboratory test evidence.
Treatment of PANDAS
The most effective treatment for PANDAS are medication and cognitive behavioral therapy, specifically exposure and response prevention (ERP). Selective serotonin reuptake inhibitor (SSRI) drugs are usually prescribed to control the symptoms of OCD. As for active strep infections, they are treated with antibiotics.
For severe and refractory symptoms, treatments such as steroids, intravenous immunoglobulin, plasmapheresis, and other types of treatment that involve controlling the immune response are proven effective.
At Kentucky Psychiatric and Mental Health Services, we provide the highest level of psychiatric care in a way that honors your Christian beliefs. Feel free to book an appointment with of our experienced mental health doctors at 502-907-5908. You may also visit our website at NextStep4ADHD.com.