RESEARCHERS PROBE POSSIBLE LINK BETWEEN STREP

Oct. 10, 2002
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GAINESVILLE, Fla. --- A new University of Florida study may settle once and for all the baffling question of whether common strep infections are linked to obsessive-compulsive disorder or tics in some children.

Anecdotal reports about a possible link between strep and obsessive-compulsive disorder, or OCD, have prompted many parents to seek unproven treatments for children whose OCD symptoms worsen with streptococcal infections, researchers say.

Now, scientists at UF and the National Institute of Mental Health, or NIMH, are determined to discover whether these infections in children are truly linked with OCD. The disorder causes youngsters to repeat certain actions, such as hand-washing, in an effort to drive away unwanted thoughts.

If neuropsychiatric disorders are found to be associated with streptococcal infections, it may mean antibiotics should be given along with traditional psychotropic drugs to treat OCD or tic disorders, said Dr. Wayne K. Goodman, chairman of psychiatry at the UF College of Medicine and UF's McKnight Brain Institute.

"If we can sort out children who are at risk, it's possible some of those kids can undergo more frequent throat cultures (for diagnosis of strep) and receive prophylactic antibiotics that may prevent the chronic, unremitting course of OCD we see in older folks," Goodman said.

OCD typically begins in adolescence or early childhood. Approximately 3.3 million adults in the United States between the ages of 18 and 54 have OCD in a given year, according to the NIMH. Researchers believe it is prevalent in 1 percent of children.

Aided by a $2.7 million NIMH grant, Goodman and Dr. Tanya Murphy, an associate professor of psychiatry at UF, will lead a five-year study designed to test for strep infections in two groups of 60 children who have OCD. Meanwhile, the NIMH will study two groups of children at its headquarters in Bethesda, Md.

"The main goal of the research is to look for a definitive association of strep with these neuropsychiatric symptoms of OCD to see if strep causes them to get worse," Murphy said.

Strep infections are common in school-age children. Depending on the season - strep peaks in December and January - more than one in three children will be infected, said Dr. Sue Swedo, chief of the NIMH's Pediatrics and Developmental Neuropsychiatry Branch.

Swedo pioneered the hypothesis that strep-triggered antibodies may attack brain cells in a small percentage of young patients who develop OCD. She called the condition PANDAS, short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus.

Parents shouldn't be alarmed if their children get strep throat, but they should make sure their children finish taking prescribed medication, even if sore-throat symptoms disappear, Swedo said.

In the meantime, researchers warn parents of children with OCD not to try unproven treatments, such as intravenous doses of immunoglobulins or preventive antibiotics.

"Some primary care doctors put children on antibiotics because parents request it, but I advise against it. There's little research to prove that what they're treating exists," Murphy said. "However, it is not a bad idea if the child presents suddenly with OCD to have the child cultured for strep and, if the culture is positive, then treat with antibiotics."

A 10-year-old boy who joined the UF study had experienced frequent infections, which prompted his family to wonder if they were connected to his OCD.

"We saw articles about strep throat and OCD on the Internet. In the meantime, our son had continual infections," said the boy's father, Chris Maxson, a medical manufacturer's representative in the Tampa area. "When we talked to adults who had OCD, they said their tough times were when they had colds. Suddenly, things started to make sense.

"Our son became uncontrollable - he couldn't go to school," Maxson said. "If he dropped a sandwich, he'd feel horrible because the sandwich didn't have a chance to be eaten. There was nothing an average parent could do. Now, under the treatment of Dr. Murphy and Dr. Goodman (at Shands at UF), you can't tell the difference between my son and any other boy his age."

Maxson said UF physicians decreased his son's prescribed dosages of the drugs Prozac and BuSpar and also introduced his son to a therapist who shows him how to recognize his "magical" thoughts.

"People often look at these illnesses and think, well, that's just a weak person," Maxson said. "But that's not the case."

"A connection (between strep and OCD), if proven, will provide a welcome change for children and families who've often heard the problem was all in their heads and that they need to pull themselves up by their bootstraps," Swedo said. "It will suggest that kids can't get better on their own; they need help."