Is it true that strep throat can trigger an episode of obsessive compulsive disorder in children?

This is a controversial topic being studied by medical experts, says Diana Pohlman, executive director of the PANDAS Network, a parent advocacy group that’s an outreach partner of the National Institute of Mental Health. PANDAS is the name for the issue being explored — Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep. “We’re just starting to track how many cases we have,” Pohlman says.

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PANDAS is defined by its clinical presentation: an unusually abrupt onset of obsessions, compulsions and eating restrictions that occurs after an untreated strep infection, says Dr. Susan Swedo, head of the NIMH’s section on behavioral pediatrics. These symptoms are typically accompanied by severe separation anxiety, mood swings and developmental regression such as a return to sucking the thumb, she says. Physical symptoms such as insomnia and increased urination are also common. Even though symptoms begin overnight, they can last for months or years if untreated, she says.

The disorder is treated with a combination of standard cognitive therapy, extended antibiotics and immunologic treatments such as steroids, Swedo says. A complete cure can be expected, particularly if treatment is started early, she says. The largest population that seems to be affected is ages 5 to 8, and boys outnumber girls, Swedo says.

Not every strain of strep can trigger PANDAS, and doctors are studying whether other types of infections also might be triggering such a reaction. There’s no cut-and-dried medical test to confirm PANDAS. Doctors don’t know whether it’s the strep itself that causes PANDAS or whether children who get it have a genetic trait that causes them to react to strep in this way, Pohlman says. “We’re wrestling with that right now,” she says.

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