Strep-Induced Psychiatric Illness

Case Files: Max and his Strep-Induced Psychiatric IllnessI had never seen anyone quite like “Max.”  The plunge from what appeared to be a normal 8 year-old boy to a scared, paranoid, fragile child who was grasping to hold on to reality was striking.  Max knew what many of his doctors had yet to discover, he had a raging strep infection. And, this infection, like many times in the past, would run rampant  in his body, largely undetected, causing him to experience a host of symptoms of serious mental illness.

In 1998, Dr. Susan Swedo, a researcher at the National Institute of Mental Health (NIMH), first described in the scientific literature a subtype of OCD in which children demonstrated an abrupt onset of neuropsychiatric  symptoms (OCD, tics, ADHD-like symptoms, anxiety) preceded by streptococcal infection. This syndrome was termed PANDAS, Pediatric  Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  In PANDAS, the body’s immune system is over-reactive to  strep bacteria, leading to psychiatric and neurological symptoms.

The greatest challenge for Max was the professional community’s debate over the very existence of PANDAS/PANS.


As this blog would suggest, I want to see evidence, evidence for the characteristics that define psychiatric disorders, evidence for the efficacy of treatment of these disorders, and, certainly, evidence for the etiology of their onset. While it is true that there is a growing evidence base for the existence of infection-induced mental illness, identifying which infectious agents have this potential, for whom, in what ways these reactions manifest, and how to best approach treating the symptoms and/or causes remain unclear, at best.  Thus, 14 years after its introduction, PANDAS remains controversial.  Meeting “Max” made me a believer.

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