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When Infection Triggers OCD

In 1998, Dr. Susan Swedo, a researcher at NIMH, first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric symptoms (OCD, tics, ADHD-like symptoms, anxiety) with a “saw-toothed” course, preceded by streptococcal infection.  This syndrome was termed PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to strep bacteria, leading to psychiatric and neurological symptoms.  Dr. Swedo continued to study this subgroup and investigated potential therapies, including intravenous immunoglobulin (IVIG), plasmapheresis, and antibiotic prophylaxis to prevent symptom exacerbations. PANDAS remained a little known and debated diagnosis.

Dr. Swedo, and more recently, other researchers as well, have dedicated themselves to understanding this phenomenon.

Studies suggest that PANDAS occurs more frequently in boys (2:1).  Most children affected by this disorder experience symptoms by 8 years of age. When OCD symptoms begin, they are sudden and dramatic and are typically accompanied by additional psychiatric and/or neurological symptoms.

There is strong evidence to support the immune system’s over-reactivity to bacterial infections, resulting in the production of neurological and behavioral symptoms.  However, what exactly triggers symptoms in this subset of children with OCD remains unclear and may extend beyond group A streptococci to other infectious agents (Lyme, mycoplasma), environmental, or metabolic factors.  In 2012, this syndrome’s description has been expanded to include these other potential triggers and has been named PANS, Pediatric Acute-onset Neuropsychiatric Syndrome.  Proposed diagnostic criteria include:

  • Abrupt, dramatic onset of OCD or severely restricted food intake
  • Concurrent presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following:
    • Anxiety
    • Emotional lability and/or depression
    • Irritability, aggression, and/or severe oppositional behaviors
    • Behavioral (developmental) regression
    • Deterioration in school performance
    • Sensory or motor abnormalities
    • Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency
    • Symptoms are not better explained by a known neurological or medical disorder, such as Sydenham chorea, systematic lupus erythematosus, Tourette’s disorder or others

It is clear is that there is a subset of OCD in children and adolescents in which there is a very sudden and acute onset that is accompanied by additional neuropsychiatric symptoms. The course is then relapsing-remitting.  In such cases, PANDAS/PANS should be considered in the differential diagnosis with appropriate history, physical, and laboratory studies such as a strep titer. Some physicians prescribe prophylactic (preventative) antibiotics to keep recurrent infections at bay. Current symptom treatments typically involve cognitive behavioral therapy (Exposure and Response Prevention for OCD, Habit Reversal/comprehensive behavior therapy for tics) and medication (selective serotonin reuptake inhibitors for OCD and anti-dopaminergic agents for tics). Family education and support is also very helpful, as these symptoms can be quite stressful on the child and his/her family.

So, if a child develops OCD or other unexpected neuropsychiatric symptoms seemingly overnight, get educated, explore all possible origins with your doctor, and contact a psychologist who has specialized training in the cognitive behavioral treatment of obsessive compulsive spectrum disorders. For more information about OCD and PANDAS/PANS, visit www.ocfoundation.org.

My first experience with PANDAS,  in 2000, left such a profound impression on me. I look forward to sharing my experience with “Daniel” in a forthcoming post…

Dr. Deibler

 

When Infection Triggers OCD

Marla W. Deibler, PsyD

Marla W. Deibler, Psy.D., is a clinical psychologist and nationally-recognized expert in anxiety disorders and the obsessive-compulsive spectrum, including trichotillomania and other body-focused repetitive behaviors, obsessive-compulsive disorder, hoarding, and tic disorders. She is the Founder and Executive Director of The Center for Emotional Health of Greater Philadelphia in New Jersey, an outpatient facility specialized in providing evaluation and evidence-based, cognitive-behavioral therapies for these and other difficulties. She currently serves on the Board of Directors of OCD-NJ, the New Jersey affiliate of the International OCD Foundation (IOCDF). Dr. Deibler gained her formative clinical experiences at the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH), Children’s National Medical Center, and the Kennedy Krieger Institute at Johns Hopkins University Medical Center. She gained specialized behavior therapy experience in the treatment of obsessive-compulsive spectrum disorders at the nationally-recognized Behavior Therapy Center of Greater Washington. Dr. Deibler served as a clinician at the National Center for Phobias, Anxiety, and Depression. She also served as Director of Behavioral Sciences at the Temple University School of Dentistry and served on the clinical faculty at Temple University Schools of Medicine and Allied Health as well as Temple University Children’s Medical Center. Dr. Deibler has published scientific research in peer-reviewed journals and has presented clinical training seminars and research findings at national and international meetings. She has appeared on the Dr. Oz Show, A&E’s “Hoarders”, TLC’s “Hoarding: Buried Alive”, CBS News, ABC News, FOX News, It’s Your Call with Lynn Doyle (CN8, Retirement TV), and CBS’s “Swift Justice with Nancy Grace”. She has been quoted by media outlets, including the Wall Street Journal, CNN, Philadelphia Inquirer, Philadelphia Daily News, and the Connecticut Post, among others. Dr. Deibler holds licenses to practice psychology in New Jersey (Lic. No. 35S100438000) and Pennsylvania (Lic. No. PS0157790). She is an active member of the American Psychological Association, Trichotillomania Learning Center, International OCD Foundation, OCD-New Jersey, Association for Behavioral and Cognitive Therapies, and Anxiety Disorders Association of America. Dr. Deibler resides in suburban Philadelphia with her husband (who is also a psychologist) and three children.


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APA Reference
Deibler, M. (2012). When Infection Triggers OCD. Psych Central. Retrieved on February 21, 2019, from https://blogs.psychcentral.com/therapy-that-works/2012/11/when-infection-triggers-ocd/

 

Last updated: 19 Nov 2012
Last reviewed: By John M. Grohol, Psy.D. on 19 Nov 2012
Published on PsychCentral.com. All rights reserved.