Elsevier

Biological Psychiatry

Volume 67, Issue 7, 1 April 2010, Pages 684-691
Biological Psychiatry

Archival Report
Streptococcal Upper Respiratory Tract Infections and Psychosocial Stress Predict Future Tic and Obsessive-Compulsive Symptom Severity in Children and Adolescents with Tourette Syndrome and Obsessive-Compulsive Disorder

https://doi.org/10.1016/j.biopsych.2009.08.020Get rights and content

Background

One goal of this prospective longitudinal study was to identify new group A beta-hemolytic streptococcal infections (GABHS) in children and adolescents with Tourette syndrome (TS) and/or obsessive-compulsive disorder (OCD) compared with healthy control subjects. We then examined the power of GABHS infections and measures of psychosocial stress to predict future tic, obsessive-compulsive (OC), and depressive symptom severity.

Methods

Consecutive ratings of tic, OC, and depressive symptom severity were obtained for 45 cases and 41 matched control subjects over a 2-year period. Clinical raters were blinded to the results of laboratory tests. Laboratory personnel were blinded to case or control status and clinical ratings. Structural equation modeling for unbalanced repeated measures was used to assess the sequence of new GABHS infections and psychosocial stress and their impact on future symptom severity.

Results

Increases in tic and OC symptom severity did not occur after every new GABHS infection. However, the structural equation model found that these newly diagnosed infections were predictive of modest increases in future tic and OC symptom severity but did not predict future depressive symptom severity. In addition, the inclusion of new infections in the model greatly enhanced, by a factor of three, the power of psychosocial stress in predicting future tic and OC symptom severity.

Conclusions

Our data suggest that a minority of children with TS and early-onset OCD were sensitive to antecedent GABHS infections. These infections also enhanced the predictive power of current psychosocial stress on future tic and OC symptom severity.

Section snippets

Subjects

The 86 subjects in this study were aged 7 to 17 years. Forty-five case and 41 healthy control subjects were recruited. During a 2-year study period, participants were monitored, on average, monthly by telephone and thrice-yearly with in-person visits. All patients were followed at the Yale Child Study Center (April 1999–September 2004) (18, 19, 20). Community control subjects were recruited from a list of 10,000 names purchased from a telemarketing company. Control subjects were group-matched

Description of Study Cohort

Apart from sex, the cases and control subjects had similar demographic characteristics (Table S1 in Supplement 1). Eleven cases were given a presumptive diagnosis of PANDAS (probable or definite) based on their history (3). With the exception of sex, the PANDAS cases were similar to non-PANDAS cases and unaffected control subjects with respect to mean age, ethnicity, parent education, and age of symptom onset (Table S2 in Supplement 1).

At baseline, cases had higher ratings of anxiety and

Discussion

During this blinded, prospective longitudinal study, periods of tic and OC symptom worsening were independently associated with antecedent newly diagnosed GABHS infections as well as higher levels of antecedent psychosocial stress. Compared with the earlier reports from the same sample (12), two novel findings appear. First, the impact of psychosocial stress is stronger when antecedent newly diagnosed GABHS infections are also considered in the model (Figure 1A and 1B). Second, in this analysis

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