Neuropsychiatric manifestations of Sydenham's chorea: a systematic review.
OBJECTIVE
Sydenham's chorea is a post-streptococcal, autoimmune, neuropsychiatric movement disorder. Sydenham's chorea is a major criterion for diagnosis of acute rheumatic fever with the implication of potential long-term sequelae including cardiac complications. It is well established that there is psychiatric comorbidity in Sydenham's chorea, but there are variations in the literature regarding the nature and prevalence of psychiatric diagnoses associated with Sydenham's chorea. The aim of this review was to systematically evaluate the evidence for psychiatric symptoms presenting with Sydenham's chorea. Knowledge of comorbid psychiatric symptomatology will support early diagnosis and treatment, leading to improved long-term outcomes for children with Sydenham's chorea.


METHODS
The study used a systematic search strategy, using MEDLINE, MEDLINE in Process, EMBASE, and The Cochrane Library. Abstracts were screened to identify relevant papers which were then assessed further. Eligible papers were summarized.


RESULTS
A total of 1429 abstracts of relevant studies were found, and 49 papers reporting neuropsychiatric symptoms in Sydenham's chorea were summarized. Obsessive-compulsive disorder was the most commonly studied, and hence reported, neuropsychiatric symptom in children with Sydenham's chorea. The studies analysed used a variety of tools to identify affected children and used different methods for analysing results. Attention-deficit-hyperactivity disorder, affective disorders, tic disorders, executive function disturbances, and psychotic features were also reported as comorbidities.


CONCLUSIONS
There is good evidence of neuropsychiatric comorbidities in Sydenham's chorea. In countries with a high prevalence of rheumatic fever, the early recognition of salient cognitive and psychiatric symptoms may aid in the management of Sydenham's chorea.
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Caledonia House, Royal Hospital for Sick Children, University of Glasgow, Yorkhill, Glasgow, UK.
Mallika
M
Punukollu
Liaison Psychiatry Team, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Nadine
N
Mushet
Department of Child and Adolescent Psychiatry, Midpark Hospital, Dumfries, UK.
Marisa
M
Linney
National Child Inpatient Unit, Caledonia Ward, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Colm
C
Hennessy
Liaison Psychiatry Team, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Michael
M
Morton
D000328:Adult; D002648:Child; D002819:Chorea / Q000453:epidemiology / Q000503:physiopathology*; D015897:Comorbidity; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000503:physiopathology*