Obsessive-compulsive spectrum disorders in rheumatic fever with and without Sydenham's chorea.
BACKGROUND
Recent findings suggest that acute-phase rheumatic fever (RF) patients present with higher frequencies of obsessive-compulsive disorder (OCD) and tic disorders. Until now, there have been no such studies in RF in non-acute phases.


OBJECTIVE
To verify whether patients with a history of RF with or without Sydenham's chorea (SC) present with higher rates of OCD, tic disorders, and other obsessive-compulsive (OC) spectrum disorders (such as body dysmorphic disorder [BDD]) than controls.


METHODS
Between February 1999 and December 2002, 59 consecutive outpatients with non-acute RF (28 with and 31 without SC) from an RF clinic and 39 controls from an orthopedics clinic were blindly assessed for OC spectrum disorders using structured interviews to assign DSM-IV diagnosis. Data were analyzed with Fisher exact and chi(2) tests to compare frequencies of disorders, and Kaplan-Meier survival analyses were used to obtain age-corrected rates.


RESULTS
The age-corrected rates of tic disorders were higher in patients with RF without SC (N = 3; 14.39%) (p =.003) when compared with controls. Age-corrected rates for OC spectrum disorders (OCD, tic disorders, and BDD) combined were higher both in RF without SC (N = 4; 20.65%) and RF with SC (N = 5; 19.55%) groups than in controls (N = 1; 2.56%) (p =.048).


CONCLUSIONS
RF, even in the non-acute phase, may increase the risk for some OC spectrum disorders, such as OCD, tic disorders, and BDD. These data, although preliminary, reinforce the idea that OC spectrum disorders may share common underlying pathophysiologic mechanisms and vulnerability factors with RF or that RF could trigger central nervous system late manifestations such as OC spectrum disorders.
Psychiatry Department, Medical School of the University of São Paulo (HCFMUSP), São Paulo, Brazil. anah@protoc.com.br
Ana Gabriela
AG
Hounie
David L
DL
Pauls
Marcos Tomanik
MT
Mercadante
Maria Conceição
MC
Rosário-Campos
Roseli Gedanke
RG
Shavitt
Maria Alice
MA
de Mathis
Pedro Gomes
PG
de Alvarenga
Mariana
M
Cúri
Euripedes Constantino
EC
Miguel
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002819:Chorea / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004198:Disease Susceptibility / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology*; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology; D016019:Survival Analysis; D013981:Tic Disorders / Q000175:diagnosis / Q000453:epidemiology