By: Drs. Erich Storch and Jason Gallant 

While trying to come up with topics for the articles from experts, a woman saw my article in the local paper and e-mailed me.  She suggested that, based on my background story, it was likely that my OCD was at least exacerbated by the 10 cases of strep throat I had during first grade.  I decided to go to the experts at the University of Florida OCD Program for information.  They replied with this article:

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a fairly recent phenomenon wherein Obsessive Compulsive Disorder and tic Disorders originate or are made worse from a streptococcal infection. PANDAS is thought to occur when antibodies produced by the body, to ward off bacterial strep infections, mistakenly attack a portion of the brain called the basal ganglia (Larson, Storch, & Murphy, 2005; Snider & Swedo, 2004).

One is thought to have PANDAS if five conditions are present (Swedo et al., 1998). First, there must be symptoms of an Obsessive Compulsive Disorder and/or a tic disorder. Secondly, symptom onset must occur prior to puberty (ages 3 through 13). Third, as opposed to what is generally seen in Obsessive Compulsive Disorder, PANDAS has a sudden and severe onset. Individuals with PANDAS describe the onset as a “sudden explosion of symptoms”.  Furthermore, PANDAS is associated with neurological abnormalities. For example, unusual muscular movements are commonly seen in these patients. Most importantly, a group A beta-hymolytic streptococcal infection (e.g., a strep infection) is or was present. Lastly, in order for PANDAS to be considered, there must be at least two obsessive compulsive and/or tic incidents (Larson et al., 2005; March, 2004; Swedo et al., 1998).

Case studies suggest that children and adolescents with PANDAS experience similar impairments as those with Obsessive Compulsive Disorder and tic disorders (Allen, Leonard, & Swedo, 1995; Gabbay & Coffey, 2003; Larson et al., 2005). For example, 40% of youth have some other psychiatric condition along with their PANDAS. Thus, the seriousness of the disorder warrants the need for special educators, psychologists, and other professionals to be aware of both symptoms and treatment options.

Treatment research for PANDAS has focused primarily on antibiotics and immunomodulatory therapies (e.g., plasma exchange). However, neither of these two treatment approaches prove to be all that effective.  More recently, Storch and colleagues (2004) found cognitive behavioral therapy to be an effective treatment approach. Despite these initial promising findings, more research is needed to test the effectiveness of varying treatment approaches (e.g., cognitive behavioral therapy vs. antibiotics) and to clearly define an easier way of diagnosing PANDAS (Larson et al., 2005). Lastly, those close to the child should be aware of sudden out-of character behaviors following a sore throat such as obsessive thinking, muscular and coordination problems, repetitive behaviors, and signs similar to those seen in Attention-Deficit/Hyperactivity Disorder. 

References

Allen, A.J., Leonard, H.L., & Swedo, S.E. (1995). Case study: A new infection-triggered, autoimmune subtype of pediatric OCD and Tourette’s syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 307-311.

Gabbay, V., & Coffey, B. (2003). Obsessive-Compulsive Disorder, Tourette’s Disorder, or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus in an adolescent? Diagnostic and therapeutic challenges. Journal of Child and Adolescent Psychopharmacology, 13, 209-212.

Larson, M.J., Storch, E.A., & Murphy, T.K. (2005). Is it PANDAS? How to confirm the sore throat/OCD connection. Current Psychiatry, 4, 33-48.

March, J.S. (2004). Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Infections (PANDAS): Implications for clinical practice. Archives of Pediatrics and Adolescent Medicine, 158, 927-929.

Snider, L.A., & Swedo, S.E. (2004). PANDAS: Current status and directions for research. Molecular Psychiatry, 9, 900-9007

Storch, E.A., Gerdes, A.C., Adkins, J.W., Geffken, G.R., Star, J., & Murphy, T. (2004). Behavioral treatment of a child with PANDAS. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 510-511.

Swedo, S.E., Leonard, H.L., Garvey, M., Mittelman, B., Allen, A.J., Perlmutter, S., Lougee, L., Dow, S., Zamkoff, J., & Dubbert, B.K. (1998). Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus: Clinical description of the first 50 cases. American Journal of Psychiatry, 155, 264-271.

Dr. Storch is an Assistant Professor of Clinical Psychology in Psychiatry at the University of Florida, with additional academic appointments in the Departments of Pediatrics, Psychology, and Educational Psychology. Dr. Storch specializes in the cognitive behavioral treatment of adult and childhood obsessive compulsive disorder (OCD). Dr. Storch earned his BA in Psychology from Binghamton University in 1997, and followed by his M.S., M.Phil., and Ph.D. degrees in Child-Clinical Psychology from Columbia University. He joined the Faculty of the Department of Psychiatry at the University of Florida in 2004. He is a licensed clinical psychologist and serves as the Director of Cognitive Behavioral Therapy and Research in the UF OCD Program. He is conducting research in the areas of cognitive behavioral treatment for adult and childhood OCD, treatment augmentation, and symptom assessment.