title: Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics.
abstract: BACKGROUND
  A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus.
  
  
  METHODS
  Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277).
  
  
  RESULTS
  Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03).
  
  
  CONCLUSIONS
  Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations.
authors.affiliation: Department of Psychiatry, University of Florida, Gainesville, Florida 32610-0256, USA.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: Muhammad
authors.initials: M
authors.lastname: Sajid
authors.forename: Ohel
authors.initials: O
authors.lastname: Soto
authors.forename: Nathan
authors.initials: N
authors.lastname: Shapira
authors.forename: Paula
authors.initials: P
authors.lastname: Edge
authors.forename: Mark
authors.initials: M
authors.lastname: Yang
authors.forename: Mark H
authors.initials: MH
authors.lastname: Lewis
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology*; D001426:Bacterial Proteins; D002241:Carbohydrates / Q000276:immunology; D002648:Child; D003851:Deoxyribonucleases / Q000276:immunology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000097:blood / Q000276:immunology* / Q000382:microbiology*; D013301:Streptolysins / Q000276:immunology; D020323:Tics / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D014743:Videotape Recording
chemical_list: D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D002241:Carbohydrates; D013301:Streptolysins; C025964:streptolysin O; D003851:Deoxyribonucleases; C020069:deoxyribonuclease B