OCD

OCD and PANDAS

When children present with difficult or extreme behaviors they are often given a mental health diagnosis without considering whether an infection might be the underlying cause of the disorder. A developing area of medicine is increasingly taking a look at the relationship between strep infections and conditions such as obsessive-compulsive disorder (OCD) and tics (Tourette’s). The disorder is known as PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. This is the same type of strep infection that causes sore throats. It’s called Group A Strep.

In order to understand PANDAS, you need to understand a little about how the body works to fight infections.

How Your Body Fights Infection

When bacteria invade the system, inflammation develops and our bodies produce antibodies to fight back. Strep is a particularly vicious bacteria, and strep antibodies can be equally dangerous. This is why you must always make sure that your child takes the full course of prescribed antibiotics for strep infections. Usually all goes according to plan and the patient heals, but sometimes the antibodies mistakenly attack healthy tissue. Rheumatic fever results when strep antibodies attack the heart. Nephritis results when strep antibodies attack the kidneys.

PANDAS results when strep antibodies attack the brain. The obsessions, compulsions, and/or tics in PANDAS children are signs of the infection. And once PANDAS is triggered, subsequent exacerbations in behaviors can be due to unrelated infections, whether caused by bacteria or viruses.

The most famous case of PANDAS is the subject of the book Saving Sammy: A Mother’s Fight to Cure Her Son’s OCD by Beth Alison Maloney. Sammy was twelve years old when he was suddenly overcome with obsessions and compulsions. He was diagnosed with OCD and later with Tourette’s. After a year his mother figured out through a blood test that he had an undiagnosed strep infection, and that Sammy needed antibiotics. It was a long road to recovery, but today Sammy is fully healed, takes no medication, and is a successful college student.

Sammy’s case was particularly challenging because he never had any traditional symptoms of strep, not even a sore throat. His extreme behaviors were the only symptoms of his infection. You can learn more about Sammy’s case and find the book by visiting www.savingsammy.net.

How to Recognize PANDAS

As with every new area of medicine, different doctors have conflicting viewpoints. Not every child with OCD or Tourette’s has an underlying infection, but if your child has any of the symptoms on the checklist below it certainly may be worth exploring this possibility with your doctor. Here are some of the behaviors that may indicate the presence of PANDAS:

Obsessive-compulsive behaviors: can include repetitive behaviors, excess fear of germs, hair pulling and eating disorders
Motor and verbal tics (Tourette’s)
ADHD symptoms (hyperactivity, inattention, fidgety)
Extreme separation anxiety (child is “clingy” and has difficulty separating from his or her caregivers
Mood changes (irritability, sadness, emotional swings)
Sleep disturbance
Nighttime bedwetting and/or daytime urinary frequency
Fine/gross motor changes (e.g. changes in handwriting)
Joint pains

There are three tests to detect strep: a rapid throat swab, a throat culture, and a blood test (ASO titer and Anti-DNAse antibodies). The blood test is the only definitive way to know if a child has been infected. And if your child has recurrent strep infections, all the members of the household should be tested. “Silent strep” is not as uncommon as you might think; adults, children, and even the family dog can carry the bacteria without any symptoms. If you suspect PANDAS, but your child’s swab and culture come back negative, don’t hesitate to ask for the blood test. It’s an easy test, and the result may that may lead you to explore different treatment options.