The Perfectionist's Handbook

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Can Infections Result in Mental Illness?

New paper outlining infectious based causes of OCD

Can infections result in mental illness? Dr. Thomas Insel, Director of the National Institutes of Mental Health, commented in his blog over a year ago: "The increasing evidence linking strep infection to OCD in children suggests that microbiomics may prove an important research area for understanding and treating mental disorders." (To read Dr. Insel's entire blog go here: http://1.usa.gov/ahPPDz)

So what is Dr. Insel referring to? Consider this. You are the parent of a six-year-old child. He is friendly, outgoing and active and doing well in school. Recently, he has been sick with strep, but in the past few days he has been feeling better. Thursday morning, however, you wake up to the sound of him screaming. You can't calm him down. All you can gather is something about germs and fear and danger. The morning is consumed with attempts to comfort him and try to understand what is going on. Getting to school isn't an option. Over the next few days, it gets worse. You know a little bit about Obsessive Compulsive Disorder (OCD) and begin to wonder whether your child suddenly has it. How can this be?

At the International OCD Foundation we hear story after story about this seemingly overnight transformation of a well-adjusted child who develops sudden onset OCD or what we now understand as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep). I have seen the before and after videos. They are chilling. In one clip, a typical happy go lucky kid with a time stamp of August 10, 2010. In the next, a screaming, terrified child and bewildered parents. Time stamp of August 12, 2010. Then I saw the handwriting samples. Handwriting? Yes. Apparently what is happening to these children is that the infection is somehow crossing the blood brain barrier and inflaming a brain structure called the Basal Ganglia. This structure is also implicated in OCD symptoms, as well as fine motor movements (i.e., handwriting) and urinary control (i.e., a child who hasn't wet the bed in years begins to again—or feels urinary urgency all day long).

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The initial description of PANDAS was published in 1998. However, in 2010, a conference co-sponsored by the National Institutes of Mental Health and the International OCD Foundation convened researchers and clinicians around the country to discuss the possibility that infections resulting in OCD may not be limited to strep. Dr. Susan Swedo and her colleagues just published a paper in Pediatric Therapeutics detailing this new understanding which now expands the idea of PANDAS to PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) underscoring that other infections can trigger these symptoms. (To see this article in its entirety go here: http://ocfoundation.org/PANDAS/)

Here are the symptoms of PANDAS or PANS to be on the look out for:

• Acute sudden onset of OCD
• Challenges with eating, and at the extreme end, anorexia
• Sensory issues such as sensitivity to clothes, sound, and light
• Handwriting gets noticeably worse
• Changes in urinary frequency or bedwetting
• Small motor skills get worse—a craft project from yesterday is now impossible to complete
• Tics
• Easily distracted, unable to focus or keep attention, and has problems with memory
• Overnight onset of anxiety or panic attacks over things that were no big deal a few days ago, such as thunderstorms or bugs
• Suddenly unable to separate from their caregiver, or to sleep alone

In order to raise awareness of PANDAS and PANS, the International OCD Foundation has developed two new Public Service Announcements—one aimed at parents and the other for physicians. If you are a parent and your child recently developed severe sudden-onset OCD:

1. Call your doctor immediately.
2. Check for signs of active infection, especially strep. Treat any infection promptly
3. Contact us at www.ocfoundation.org to find an OCD specialist in your area.

If you are a pediatric mental health professional or pediatrician and you are seeing a child with sudden onset OCD:

1. Test for active infections, especially strep even if several weeks have passed since onset
2. Treat any active infections thoroughly
3. Contact us at www.ocfoundation.org to team up with an OCD specialist to help create a treatment plan

Early treatment may prevent life-long mental illness.

 

Jeff Szymanski, Ph.D., is the Executive Director of the International OCD Foundation and author of The Perfectionist's Handbook.

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