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PANDAS: An Autoimmune Form of Childhood OCD

Childhood OCD Can Be Triggered By Infection

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Updated July 15, 2014

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Could Childhood OCD be an Autoimmune Disorder?

Although we usually think of our immune system as protecting us from outside invaders such as bacteria, viruses and other germs, it can get confused and attack our own body. When this happens we are said to suffer from an autoimmune disorder.

You are probably already aware of a number of autoimmune disorders such as rheumatoid arthritis, type 1 diabetes, lupus and multiple sclerosis. Although obsessive-compulsive disorder (OCD) is usually thought to be caused by combination of stress, genetic predisposition and disruption of neurochemicals such as serotonin, there is growing evidence that a specific form of childhood of OCD may actually be an autoimmune disorder.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

The Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections or “PANDAS” form of OCD is thought to be triggered by an infection of the same bacteria that causes strep throat and scarlet fever. As the child’s immune system fights the strep infection, it becomes confused and starts to attack an area of the brain called the basal ganglia. Although changes in a number of brain areas underlie symptoms of OCD, abnormalities of the basal ganglia have been associated with symptoms of OCD.

Of course, strep throat is a common infection and not all children who develop this infection will develop the PANDAS form of OCD. Research has shown that only those children who are genetically predisposed to OCD or tics are vulnerable to developing this form of OCD.

How is the PANDAS Form of OCD Diagnosed?

About 25% of children with OCD have the PANDAS subtype. The PANDAS form of OCD has a few key symptoms that lets doctors distinguish it from more typical forms of childhood OCD. For example:

  • Whereas the symptoms of regular OCD develop slowly, the onset of the PANDAS form of OCD is rapid.

  • The PANDAS form of OCD occurs in close association with a strep infection. However, regular OCD can occur at anytime. Confirmation of a strep infection is usually done using a throat culture and/or blood test for strep antibodies.

  • Unlike regular OCD, children with the PANDAS form of OCD usually have involuntary movements of the arms, legs and face.

  • The PANDAS form of OCD usually develops between the ages of 3 and before puberty.

Other symptoms of the PANDAS form of OCD include:

  • Irritability, temper tantrums and problems with mood.

  • Severe nightmares and new rituals around bedtime.

  • Increased anxiety.

  • New problems with fine motor or math skills or problems with other senses.

How is PANDAS OCD Treated?

Although regular OCD is usually treated with medication such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behaviour therapy, the PANDAS form of OCD can require different treatment.

If the PANAS form of OCD is suspected, the first line of treatment is a round of antibiotics to knock out the strep infection. Sometimes more invasive procedures such as a plasma exchange are necessary to removes harmful antibodies from the bloodstream. Plasma exchange usually involves going to the hospital.

Although most children will recover following treatment with antibiotics, sometimes symptoms of OCD can remain. These residual symptoms may be effectively treatment with standard treatments for regular OCD such as medications or psychotherapy.

Can Adults Develop PANDAS OCD?

Although there is evidence that changes in the immune system sometimes accompany mental illnesses like depression and schizophrenia, there is no conclusive evidence that problems with the immune system are related to development of adult forms of OCD. So far, it appears that strep infections can only trigger symptoms of OCD in children between the ages of 3 and puberty.

Sources:

Filardi da Rocha, F., Correa, H., & Teixeira, A.L. “Obsessive-compulsive disorder and immunology: a review” Progress in Neuro-Psychopharmacology & Biological Psychiatry 2008 32: 1139-1146.

Arnold, P.D. & Richter, M.A. “Is obsessive-compulsive disorder an autoimmune disease?” Canadian Medical Association Journal 13 November 2001 165:1353-1358.

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