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PANDAS don't like stress

PANDAS is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. This diagnosis was created when clinicians observed that following streptococcal infections, which include strep throat, scarlet fever, and impetigo, children developed tics and symptoms of obsessive-compulsive disorder (OCD).

In a new longitudinal study appearing in Biological Psychiatry, published by Elsevier, researchers identified new infections in children and adolescents with Tourette syndrome (TS) and/or OCD, and compared them with healthy control subjects.

They also measured the participants' levels of emotional stress. Prior research has shown that stress is an important factor in developing depression, and that individuals with TS or OCD tend to be particularly sensitive to stress.

They then used this data to examine the power of the infections and measures of psychosocial stress to predict future tic, obsessive-compulsive, and depressive symptom severity.

Dr. James Leckman, senior author of this project, explains their findings: "We found that periods of tic and OC symptom worsening were independently associated with antecedent newly diagnosed strep infections as well as higher levels of antecedent psychosocial stress. When we looked at just the PANDAS, we also found similar results."

In other words, stress may aggravate the impact of prior streptococcal infection in promoting symptoms of TS and OCD. There was no impact of prior streptococcal infections on depressive symptoms.

PANDAS remain a controversial topic for many Tourette's experts. For example, another recently completed intensive longitudinal study that tracked a larger number of PANDAS cases found little evidence to support a link between newly diagnosed strep infections and a marked worsening of tic or obsessive-compulsive symptoms.

PANDAS is also frequently diagnosed in the community without the application of all the published diagnostic criteria. This has resulted in unwarranted use of antibiotic treatment for TS or OCD when there is no evidence of a recent strep infection.

However, some version of PANDAS likely does exist. The typical PANDAS case appears to have an abrupt sudden onset of separation anxiety and obsessive-compulsive symptoms, a loss of writing skills, and sleep problems. Tics are often present, but they can also confuse the picture, especially if they had been present in some form prior to PANDAS onset.

It is important to note that the number of PANDAS cases in this study was too small to allow firm conclusions, but it does indicate how important psychosocial stress is in TS and OCD, as well as depression.

Notes to Editors:

The article is "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" by Haiqun Lin, Kyle A. Williams, Liliya Katsovich, Diane B. Findley, Heidi Grantz, Paul J. Lombroso, Robert A. King, Debra E. Bessen, Dwight Johnson, Edward L. Kaplan, Angeli Landeros-Weisenberger, Heping Zhang, and James F. Leckman. Lin, Williams, Katsovich, Findley, Grantz, Lombroso, King, Landeros-Weisenberger, Zhang, and Leckman are affiliated with the Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut. Bessen is from the Department of Microbiology and Immunology, New York Medical College, Valhalla, New York. Johnson and Kaplan are from the World Health Organization, Streptococcal Reference Laboratory, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota.

The article appears in Biological Psychiatry, Volume 67, Issue 7 (April 1, 2010), published by Elsevier.

The authors' disclosures of financial and conflicts of interests are available in the article.

Full text of the article mentioned above is available upon request. Contact Maureen Hunter at to obtain a copy or to schedule an interview.

About Biological Psychiatry

This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

Biological Psychiatry ( is ranked 4th out of the 101 Psychiatry titles and 14th out of 219 Neurosciences titles on the 2008 ISI Journal Citations Reports® published by Thomson Scientific.

About Elsevier

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including the Lancet ( and Cell (, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect (, Scopus (, Reaxys (, MD Consult ( and Nursing Consult (, which enhance the productivity of science and health professionals, and the SciVal suite ( and MEDai's Pinpoint Review (, which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier ( employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (, a world-leading publisher and information provider. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Maureen Hunter | EurekAlert!
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