title: Improvement of psychiatric symptoms in youth following resolution of sinusitis.
abstract: BACKGROUND
  Accumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis.
  
  
  METHODS
  We reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis.
  
  
  RESULTS
  10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up.
  
  
  CONCLUSIONS
  Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed.
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: tmahony@stanford.edu.
authors.forename: Talia
authors.initials: T
authors.lastname: Mahony
authors.affiliation: Pediatric Division of Otolarynthology, Stanford University School of Medicine, 730 Welch Road, Palo Alto, CA, 94304, USA. Electronic address: dsidell@stanford.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Sidell
authors.affiliation: Pediatric Division of Infectious Disease, Stanford University School of Medicine, 730 Welch Road, Palo Alto, CA, 94304, USA. Electronic address: drhayley@stanford.edu.
authors.forename: Hayley
authors.initials: H
authors.lastname: Gans
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: kbrown3@stanford.edu.
authors.forename: Kayla
authors.initials: K
authors.lastname: Brown
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: BFarhadian@stanfordchildrens.org.
authors.forename: Bahare
authors.initials: B
authors.lastname: Farhadian
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: MGustafson@stanfordchildrens.org.
authors.forename: Melissa
authors.initials: M
authors.lastname: Gustafson
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: jsherr@stanford.edu.
authors.forename: Janell
authors.initials: J
authors.lastname: Sherr
authors.affiliation: Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: mthiene@stanford.edu.
authors.forename: Margo
authors.initials: M
authors.lastname: Thienemann
authors.affiliation: Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address: jfranko@stanford.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frankovich
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D009771:Obsessive-Compulsive Disorder / Q000209:etiology; D012189:Retrospective Studies; D012852:Sinusitis / Q000188:drug therapy / Q000523:psychology* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anxiety disorders; Behavior regression; Developmental regression; Obsessive-compulsive disorder; Sinusitis; Tic disorders