ARTICLES
Psychiatric Disorders in First-Degree Relatives of Children With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

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ABSTRACT

Objective

To determine the rates of psychiatric disorders in the first-degree relatives of children with infection-triggered obsessive-compulsive disorder (OCD) and/or tics (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; PANDAS).

Method

The probands of this study were 54 children with PANDAS (n = 24 with a primary diagnosis of OCD; n = 30 with a primary diagnosis of a tic disorder). One hundred fifty-seven first-degree relatives (100 parents [93%] and 57 siblings [100%]) were evaluated for the presence of a tic disorder. One hundred thirty-nine first-degree relatives (100 parents [93%] and 39 of 41 siblings over the age of 6 [95%]) were evaluated with clinical and structured psychiatric interviews to determine the presence of subclinical OCD, OCD, and other DSM-IV Axis I disorders.

Results

Twenty-one probands (39%) had at least one first-degree relative with a history of a motor or vocal tic; 6 mothers (11%), 9 fathers (19%), and 8 siblings (16%) received this diagnosis. Fourteen probands (26%) had at least one first-degree relative with OCD; 10 mothers (19%), 5 fathers (11%), and 2 siblings (5%), received this diagnosis. An additional 8 parents (8%) and 3 siblings (8%) met criteria for subclinical OCD. Eleven parents (11%) had obsessive-compulsive personality disorder.

Conclusions

The rates of tic disorders and OCD in first-degree relatives of pediatric probands with PANDAS are higher than those reported in the general population and are similar to those reported previously for tic disorders and OCD. Further study is warranted to determine the nature of the relationship between genetic and environmental factors in PANDAS.

Section snippets

Subjects

Fifty-four children admitted to the National Institute of Mental Health (NIMH) studies of PANDAS were identified as probands for this study. The children and adolescents were referred through mental health professionals, pediatricians, neurologists, the Obsessive Compulsive Foundation, and the Tourette Syndrome Association. Inclusion criteria were the same as defined in the original PANDAS subgroup (Swedo et al., 1998): (1) a tic disorder and/or OCD fulfilling diagnostic criteria of DSM-III-R (

RESULTS

The rates of OCD, subclinical OCD, OCPD, and tic disorders are shown in TABLE 1, TABLE 2 for parents and siblings, respectively. Of the 15 parents (15%) who met criteria for the diagnosis of OCD, 5 reported a childhood onset (before age 12), 5 reported an adolescent onset (13-18 years), 2 dated the beginning of their OCD to adulthood, and 3 were not able to recall the age of onset of their OCD. Only 2 siblings received an OCD diagnosis; this number is too small to allow the use of age

DISCUSSION

The rates of OCD found in the first-degree relatives of PANDAS probands (12% total; 15% in parents; 5% in siblings) were similar to the rates of OCD in first-degree relatives of child and adolescent OCD probands reported by Lenane and colleagues (1990) (8% total; 17% in parents; 5% in siblings), and Riddle et al. (1990) (11% in biological parents). The familial frequency was also similar to that found by Pauls et al. (1995) in first-degree relatives of adult probands (10%), perhaps because more

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    The authors acknowledge the contributions of Marge Lenane, L.C.S.W.; the statistical expertise of Lynn Goldin, Ph.D., and Susan Hamburger, M.S., M.A.; and the valuable assistance of Karen Kaczynski, Molly Henry, and Eva Levine.

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