title: 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.
abstract: BACKGROUND
  One goal of this prospective longitudinal study was to identify new group A beta-hemolytic streptococcal infections (GABHS) in children and adolescents with Tourette syndrome (TS) and/or obsessive-compulsive disorder (OCD) compared with healthy control subjects. We then examined the power of GABHS infections and measures of psychosocial stress to predict future tic, obsessive-compulsive (OC), and depressive symptom severity.
  
  
  METHODS
  Consecutive ratings of tic, OC, and depressive symptom severity were obtained for 45 cases and 41 matched control subjects over a 2-year period. Clinical raters were blinded to the results of laboratory tests. Laboratory personnel were blinded to case or control status and clinical ratings. Structural equation modeling for unbalanced repeated measures was used to assess the sequence of new GABHS infections and psychosocial stress and their impact on future symptom severity.
  
  
  RESULTS
  Increases in tic and OC symptom severity did not occur after every new GABHS infection. However, the structural equation model found that these newly diagnosed infections were predictive of modest increases in future tic and OC symptom severity but did not predict future depressive symptom severity. In addition, the inclusion of new infections in the model greatly enhanced, by a factor of three, the power of psychosocial stress in predicting future tic and OC symptom severity.
  
  
  CONCLUSIONS
  Our data suggest that a minority of children with TS and early-onset OCD were sensitive to antecedent GABHS infections. These infections also enhanced the predictive power of current psychosocial stress on future tic and OC symptom severity.
authors.affiliation: Department of Epidemiology and Public Health, Yale Center for Clinical Investigation, Yale University School of Medicine, New Haven, Connecticut 06520-7900, USA.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Williams
authors.forename: Liliya
authors.initials: L
authors.lastname: Katsovich
authors.forename: Diane B
authors.initials: DB
authors.lastname: Findley
authors.forename: Heidi
authors.initials: H
authors.lastname: Grantz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Lombroso
authors.forename: Robert A
authors.initials: RA
authors.lastname: King
authors.forename: Debra E
authors.initials: DE
authors.lastname: Bessen
authors.forename: Dwight
authors.initials: D
authors.lastname: Johnson
authors.forename: Edward L
authors.initials: EL
authors.lastname: Kaplan
authors.forename: Angeli
authors.initials: A
authors.lastname: Landeros-Weisenberger
authors.forename: Heping
authors.initials: H
authors.lastname: Zhang
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005544:Forecasting; D006801:Humans; D008016:Life Change Events; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011584:Psychology; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D020323:Tics / Q000453:epidemiology*; D005879:Tourette Syndrome / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents