Archival ReportStreptococcal 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
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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
References (66)
Tourette syndrome
Lancet
(2002)- et al.
Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture
Biol Psychiatry
(1994) - et al.
Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome
Psychoneuroendocrinology
(2008) - et al.
Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder
J Am Acad Child Adolesc Psychiatry
(1995) - et al.
Assessment of symptom exacerbations in a longitudinal study of children with Tourette syndrome or obsessive-compulsive disorder
Am J Child Adolesc Psychiatry
(2002) - et al.
Development of the Yale children's global stress index (YCGSI) and its application in children and adolescents with Tourette syndrome and obsessive-compulsive disorder
Am J Child Adolesc Psychiatry
(2003) - et al.
The Yale Global Tic Severity Scale: Initial testing of a clinician-rated scale of tic severity
Am J Child Adolesc Psychiatry
(1989) - et al.
Children's Yale-Brown Obsessive Compulsive Scale: Reliability and validity
Am J Child Adolesc Psychiatry
(1997) - et al.
Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version: Initial reliability and validity data
Am J Child Adolesc Psychiatry
(1997) - et al.
Mycoplasma pneumoniae infection and Tourette's syndrome
Psychiatry Res
(2004)
Long-term follow-up of an adolescent who had bilateral striatal necrosis secondary to Mycoplasma pneumoniae infection
Brain Dev
Decreased numbers of regulatory T cells suggest impaired immune tolerance in children with Tourette syndrome: A preliminary study
Biol Psychiatry
Plasma interleukin-1 beta and tumor necrosis factor concentrations in obsessive-compulsive disorders
Biol Psychiatry
Increased serum levels of tumour necrosis factor-alpha and IL-12 in Tourette's syndrome
Biol Psychiatry
Antibodies against neural, nuclear, cytoskeletal, and streptococcal epitopes in children and adults with Tourette's syndrome, Sydenham's chorea, and autoimmune disorders
Biol Psychiatry
Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection
Pediatr Neurol
Antineuronal antibodies in a group of children with obsessive-compulsive disorder and Tourette syndrome
J Psychiatr Res
Neuronal surface glycolytic enzymes are autoantigen targets in post-streptococcal autoimmune CNS disease
J Neuroimmunol
Identification of pyruvate kinase as an antigen associated with Tourette syndrome
J Neuroimmunol
Striatal antibodies in children with Tourette's syndrome: Multivariate discriminant analysis of IgG repertoires
J Neuroimmunol
Antibody-mediated neuronal cell signaling in behavior and movement disorders
J Neuroimmunol
Dopaminergic receptor D5 mRNA expression is increased in circulating lymphocytes of Tourette syndrome patients
J Psychiatr Res
Prevalence of the tic disorders and Tourette syndrome in a Swedish school population
Dev Med Child Neurol
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases
Am J Psychiatry
Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder
Pediatrics
Neuropsychiatric disorders associated with streptococcal infection: A case-control study among privately insured children
J Am Acad Child Adolesc Psychiatry
Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive-compulsive, and attention deficit/hyperactivity disorders
Arch Gen Psychiatry
Recurrent depression: Infectious-autoimmune etiology?
J Am Acad Child Adolesc Psychiatry
Psychological stress and the subsequent appearance of new brain MRI lesions in MS
Neurology
A longitudinal-study of life events and metabolic control among youths with insulin-dependent diabetes-mellitus
Health Psychol
Psychological stress and the onset of IDDM in children—a case–control study
Diabetes Care
Pediatric stress: hormonal mediators and human development
Horm Res
Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder
J Child Psychol Psychiatry
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2015, Brain ResearchCitation Excerpt :These editorials were followed by a number of research reports assessing the relationship between GAS infections and exacerbations of OCD or tic disorders, with a number of these studies failing to find a temporal association between the two (Schrag et al., 2009; Leckman et al., 2011; Kurlan et al., 2008). Methodological differences may explain the discrepant results between these studies and earlier investigations demonstrating a temporal association between GAS infections and OCD or tic symptoms (Mell et al., 2005; Lin et al., 2010); however, these findings instigated a discussion to significantly revise or discard PANDAS as a diagnostic entity (Singer et al., 2012). To address the conflicts regarding recognition and diagnosis of PANDAS, a workshop was held at National Institutes of Health in July 2010.