Article

The Psychiatric Symptoms of Rheumatic Fever

Yale University, New Haven, Connecticut, United States
American Journal of Psychiatry (Impact Factor: 13.56). 01/2001; 157(12):2036-8. DOI: 10.1176/appi.ajp.157.12.2036
Source: PubMed

ABSTRACT This study examined the frequency and age at onset of psychiatric disorders among children with rheumatic fever, Sydenham's chorea, or both and a comparison group.
Twenty children with rheumatic fever, 22 with Sydenham's chorea, and 20 comparison children were assessed by means of a semistructured interview and rating scales for tic disorders and obsessive-compulsive disorder.
Obsessive-compulsive symptoms were more frequent in both the Sydenham's chorea and rheumatic fever groups than in the comparison group. The Sydenham's chorea group had a higher frequency of major depressive disorder, tic disorders, and attention deficit hyperactivity disorder (ADHD) than both the comparison and rheumatic fever groups. ADHD symptoms were associated with a higher risk of developing Sydenham's chorea.
Both the rheumatic fever and Sydenham's chorea groups were associated with a higher risk of developing neuropsychiatric disorders than the comparison group. ADHD appears to be a risk factor for Sydenham's chorea in children with rheumatic fever.

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    • "Choreiform movements that represented an overall worsening of neurological performance were noted to occur about 3 months following a tic exacerbation (Murphy et al. 2004). This type of lag is consistent with the finding that OCD symptoms precede the appearance of any motoric manifestation by days or weeks in patients with RF (Mercadante et al. 2000). The presence of neurological soft signs, such as choreiform movements and pronator sign/drift, are a frequently observed comorbidity among childhood onset OCD, tics, and ADHD; the significance of neurological soft signs in relationship to GAS infections has never been prospectively examined until recently (Murphy et al. 2007). "
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    ABSTRACT: Obsessive-compulsive disorder (OCD) and related conditions including Tourette's disorder (TD) are chronic, relapsing disorders of unknown etiology associated with marked impairment and disability. Associated immune dysfunction has been reported and debated in the literature since the late 80s. The immunologic culprit receiving the most interest has been Group A Streptococcus (GAS), which began to receive attention as a potential cause of neuropsychiatric symptoms, following the investigation of the symptoms reported in Sydenham's chorea (SC) and rheumatic fever, such as motor tics, vocal tics, and both obsessive-compulsive and attention deficit/hyperactivity symptoms. Young children have been described as having a sudden onset of these neuropsychiatric symptoms temporally associated with GAS, but without supporting evidence of rheumatic fever. This presentation of OCD and tics has been termed pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS). Of note, SC, OCD, and TD often begin in early childhood and share common anatomic areas--the basal ganglia of the brain and the related cortical and thalamic sites--adding support to the possibility that these disorders might share a common immunologic and/or genetic vulnerability. Relevant manuscripts were identified through searches of the PsycINFO and MedLine databases using the following keywords: OCD, immune, PANDAS, Sydenham chorea, Tourette's disorder Group A Streptococcus. Articles were also identified through reference lists from research articles and other materials on childhood OCD, PANDAS, and TD between 1966 and December 2010. Considering the overlap of clinical and neuroanatomic findings among these disorders, this review explores evidence regarding the immunobiology as well as the relevant clinical and therapeutic aspects of TD, OCD, and PANDAS.
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    • "Results from several studies conducted in Brazil suggest that OCD and related disorders are more frequent in RF patients. [31] [22] [1]. A family study also found higher rates of OCD and related disorders in first-degree relatives of RF patients than in first-degree relatives of controls, suggesting a familial association between RF and OCD [21]. "
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    • "Results from several studies conducted in Brazil suggest that OCD and related disorders are more frequent in RF patients. [31] [22] [1]. A family study also found higher rates of OCD and related disorders in first-degree relatives of RF patients than in first-degree relatives of controls, suggesting a familial association between RF and OCD [21]. "
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