Immune and Endocrine Function in Child and Adolescent Obsessive Compulsive Disorder

  • Tanya K. Murphy
  • Kelley Yokum


Dr. Laurence Selling made one of the earliest reported cases of this potential correlation between the onset of tics and infectious disease in 1929 when he described three cases of tics associated with sinusitis (Selling, 1929). Subsequently, psychoanalytic theories prevailed in etiologic theories of Tourette Syndrome (TS) (Kushner & Kiessling, 1996). Just before the “medicalization” of (TS) in 1965, Langlois and Force described a 6-year-old child with TS and Sydenham chorea (SC) symptoms following several infectious illnesses that were successfully treated with antibiotics and neuroleptics (Langlois & Force, 1965). They argued that Tourette was wrong to say TS was incurable and separate from SC, but that TS should be viewed as sequel to acute chorea. After a lag of approximately 20 years, the argument reappeared that, in at least some cases, tics and obsessive compulsive disorder (OCD) are related to infectious processes. In the late 1980s, researchers noted that patients with SC often developed OCD symptoms, and further inquiry found that patients with SC often had tics as well. Additional investigation found that some patients with Group A Streptococcus (GAS) infections, but without the neurological findings of SC, also presented with OCD symptoms (Allen, Leonard, & Swedo, 1995; Swedo & Leonard, 1994). Similarly, around this same time, Louise Kiessling and colleagues reported on the association of tics during GAS outbreaks as seen in a developmental pediatric practice (Kiessling, Marcotte, & Culpepper, 1993). The first case report (Allen et al., 1995) detailed four children who presented with sudden onset or worsening of OCD and/or tics following an infection (2 viral, 2 GAS). Subsequently in 1998, based on these observations and reports, a group from the National Institute of Mental Health further characterized (in a 50 patient case series) an entity they called “pediatric autoimmune neuropsychiatric disorders associated with streptococcus” (PANDAS). Careful reading of these case series suggests that GAS is the inciting trigger, but future exacerbations are activated not only by GAS infection but GAS exposure and viral illness as well.


Obsessive Compulsive Disorder Tourette Syndrome Rheumatic Fever Corticotrophin Release Factor Necrotizing Fasciitis 
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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of South FloridaSt. PetersburgUSA

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