Is your kid prone to sore throats caused by strep infections? Does he or she exhibit symptoms of obsessive-compulsive disorder (OCD) or high anxiety? Have you ever heard of PANDAS?
PANDAS is something every parent needs to be aware of. Though a rare occurrence, in some cases a strep infection can precipitate or worsen symptoms of mental illness. Known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS, symptoms typically appear in kids between age 3 and puberty, according to the National Institute of Mental Health.
Many children at some point develop symptoms of OCD, such as tics, or anxiety and mood issues. Because these issues often present together, a child may have both symptoms of OCD and tics, which come and go over time.
The OCD symptoms may be only obsessions – a preoccupation with certain ideas or thoughts – or you may only notice compulsions, a behavior they repeat many times each day to allay anxiety, such as checking and rechecking homework or repeating a word or phrase. Tics, which also happen often enough in childhood and then frequently disappear, are an involuntary recurrent contraction of a muscle group that causes movement of a body part or a vocal sound. Many though not all children who have one also have the other.
While tics and the symptoms of OCD can be common in children — most children who develop OCD or tics do not have PANDAS. However, there does appear to be a smaller group of children who have never had any symptoms of either OCD or tics, and then after contracting a streptococcal infection suddenly seem to have an explosive case of either or both. Alternatively, some kids who have OCD or tics and then develop a strep infection, have an explosion in the severity of their psychiatric symptoms. This is the hallmark of PANDAS.
How Could a Strep Infection Cause, or Increase Symptoms of OCD?
According to Dr. Gail Saltz, a clinical associate professor of psychiatry at the New York-Presbyterian Hospital, “The streptococcus bacteria is a very old and primitive bacteria. It is able to camouflage itself as an evolutionary survival mechanism by developing molecules on its surface that appear exceedingly similar to molecules on the outside of normal human tissue cells – specifically those in the brain, heart, joints and skin. In this way, the strep bacteria can avoid detection by the body and proliferate.”
Dr. Saltz continues, “At some point, the human host does detect this sneaky bacteria and produces antibodies to fight it off – a normal immune response. However, the antibody that’s made by the human body is designed to attack what now appears very much like the normal tissue. Most often, this is not a problem and doesn’t cause significant issues. But some people will, for example, develop joint swelling and pain.”
In the case of PANDAS, she explains, those antibodies may mistakenly attack healthy brain or nervous tissue – and that is what causes the tics and the OCD symptoms in these children.
As to when to suspect it could be PANDAS, Saltz says, “If your child very suddenly develops a rip-roaring case of tics, or obsessions or compulsions when the child had no symptoms before, or if your child had a tic or OCD that wasn’t severe and suddenly symptoms get much worse, take heed.”