PANDAS, Part 2 – A paradigm shift in the treatment of mental disorders

Consider this case:

Jonny, (not his real name), is a third grader with a new problem – he cannot stay in class. After starting the year well the first week, he missed the almost the whole second week of school with a sore throat and a cold. When he came back to school, he was a different kid. He told his teacher he had to go home because he missed his mom. In fact, he wouldn’t stay in class. His parents would bring him to school, he went in the school but refused to go in the class room. He was sure something awful would happen to his parents if he did. When his dad came to school and convinced him to go in the classroom, Jonny bolted from the room in tears as soon as his dad left his view. This went on for a week with no progress. In desperation, Jonny’s parents called me for a consultation.

In reflecting upon the implications of PANDAS, I am remembering cases where autoimmune reactions associated with Strep may have been relevant. The case above is one of the more striking school refusal cases I encountered since there were no prior incidents of anxiety or phobia. The remission was equally striking. I saw them for three sessions and the boy’s phobia decreased dramatically.
My strategy was to ask the school if the boy and his mom could do his school work together in a room at school. I reasoned that there was some sudden onset of attachment anxiety. At the time, I wondered if for some reason the mother experienced attachment distress and communicated this in some way to the son. I wondered if the school refusal behavior was a communication to the father that perhaps Jonny wanted more time with dad. There were some corroborating findings. In this particular Autumn, dad was somewhat more busy in his work and gone a bit more. From a systems perspective, I had a working hypothesis that mom wanted the son to help bring dad home more and get more involved in the family. Dad was indeed too busy to attend sessions, so I worked with what I had and prescribed this change at the school. The school personnel cooperated and found a suitable room for mom and son to conduct school work.
Under these conditions, the youngster stayed at school and did his lessons. As predicted, mom and son soon got their fill of attachment and began to bicker some about various things. By the beginning of the second week, Jonny thought he could try the classroom again. After a couple of false starts, he was back in the classroom for good by week three.
Within a systems/solution focused framework, I had “prescribed the symptom” with the assumption that dramatically increased closeness would require a change in the mother-son relationship. Mom reported that she began to complain more to her husband about the school visitations and he was home a bit more. Somehow a more workable balance was restored to the family system. Mom and son found that when it came to closeness to each other, some was good, but more was not better.
Or did Jonny have untreated strep throat which eventually led to obsessions regarding attachment to his parents?
I will probably never know. I am very willing now to entertain the idea that the intervention I prescribed was not the source of the quick benefit. Rather, PANDAS or something like it may have gone into remission with the passing of time.
If the boy never again had related symptoms in the presence of streptococcal infection, he would not meet the NIMH criteria for PANDAS. The criteria are:

-Presence of a tic disorder and/or OCD;
-Pediatric onset of symptoms (age 3 years to puberty);
-Episodic course of symptom severity with sudden onset or acute exacerbations that are in:
-Temporal association with group A Beta-hemolytic streptococcal
infection (indicated by a positive throat culture for strep and/or elevated anti-streptococcal antibody titer); and
-Association with neurological abnormalities (hyperactivity/fidgetiness/restlessness, or adventitious movements such as the choreiform movements of Sydenham).

Even though Jonny might not have had PANDAS, it seems plausible that his reactions could have been triggered by his prior illness. The research program regarding PANDAS provides a new paradigm to consider with regard to the etiology of at least some psychiatric disorders. What other sudden onset autoimmune disorders could be related to bacteria or a virus? Mental health professionals are socialized and trained to attribute disorder to faulty family dynamics and/or trauma. I believe we should expand our thinking to include assessments of total health and environmental status. Careful observation was behind the discovery of PANDAS and may uncover additional syndromes. Susan Swedo et al describes this process:

…a subgroup of the patients experienced an explosive “overnight” onset of obsessions and compulsions followed by a relapsing-remitting symptom course. Closer observation revealed that the neuropsychiatric symptom relapses frequently occurred after episodes of streptococcal pharyngitis or scarlet fever…Longitudinal observations of the OCD subgroup and the patients with Sydenham’s chorea clearly demonstrated a temporal association between streptococcal infections and obsessive-compulsive symptoms.

In light of the PANDAS research, Swedo and colleagues recommend the following medical response in light of the research regarding PANDAS:

1. Laboratory testing: Children with an abrupt onset or exacerbation of OCD or tic disorder should have a throat culture obtained. If the symptoms have been present for >1 week, serial antistreptococcal titers may be indicated to document a preceding streptococcal infection. (Titers should be timed to catch the rise at 4–6 weeks.)
2. Use of antibiotics: Antibiotics are indicated only for the treatment of acute streptococcal infections as diagnosed by a positive throat culture or rapid streptococcal test. Clinical trials are underway to determine whether prophylactic antibiotics will be useful in the management of children in the PANDAS subgroup, but at present, they are not indicated. In the only placebo-controlled trial reported to date, penicillin administration failed to prevent streptococcal infections (14 of 35 infections occurred during the penicillin phase of the crossover trial), and thus there were no between-group differences in neuropsychiatric symptom severity.
3. Management of neuropsychiatric symptoms: Children in the PANDAS subgroup respond to treatment with standard pharmacologic and behavioral therapies. Obsessive-compulsive symptoms are treated best with a combination of medication (typically, a serotonin reuptake-blocking drug) and cognitive-behavior therapy, and motor and vocal tics respond to a variety of pharmacologic agents.

In the next article, I want to develop these recommendations a bit with application to counselors in mental health and school settings.
Read part one in this series here

48 thoughts on “PANDAS, Part 2 – A paradigm shift in the treatment of mental disorders”

  1. Drowssap said,

    Nothing in all of mental health is more “genetic” than autism and even that cookie has completely crumbled.
    California’s Autism Increase Not Due To Better Counting, Diagnosis

    About time! You know, you can still find articles that refer to the “heritable” nature of mental illnesses like schiz; while I understand that, yes, there is ample evidence that mental illness are clustered in some families more than others, it is truly misleading, considering all we have learned over the last several years, to keep seeing the word “heritable” instead of a phrase like “a familial connection” or “possible heritable connection.”
    After all, while they’ve identified pathogenic causes in some % of schiz, they’ve not yet identified a genetic link. I just wish there was greater attention to language.
    Considering the spread of the herpes viruses, it wouldn’t surprise me if some a lot of things will be traced to STDs. Maybe, when you think of it, STD’s are nature’s way of trying to make us monogamous and if so, it looks like we’ve not gotten the message.
    The autism numbers are astounding, no matter how they are counted, it seems. Some toxic environmental agent or something pathogenic seems to be at work. One even wonders if all the fruits and veggies that come from Central and South America might not have introduced something we are unaware of.
    I live in the the greater SF Bay Area and here in CA we have a rich source of our own fruits and vegetables from our San Joaquin and Imperial Valleys, but for a long time now, in the winter we get a steady stream of produce from out of the country. We have problems keeping track of what our own agribusiness people are doing, and my guess is that we don’t know at all what we are eating from those other countries.
    We have already had many problems with contaminated produce from Mexico. Sometimes the contaminants come from humans, and other times from irrigation contaminated by animals. One wonders.
    There are certainly many new materials in the environment that weren’t around 20-30 years ago, and they will be looked at as possible culprits and rightfully so. Certainly the processed foods we eat as well as the chemicals we use to grow food and the hormones we inject into our meats are other possible culprits, but I can think of one other thing that has changed a great deal in that time–the proliferation of kids being fed fast foods. (kind of negates what I said about fruits and veggies since so many kids never eat them).
    So much of our “food” comes out of a box –they are suspect, but what about the places that serve fast food? Think that MacDonald’s and Burger King and Taco Bell are havens for the growth of lots of creepy things? (Heck, even so-called quality restaurants are often flagged for their filth.) So, how about all those kids preparing and serving that fast food? I know, our own kitchen counters are loaded with bugs, but multiply what our families bring home to those counters to arrive at the number that abounds in some of those fast food places.
    Actually, my child-rearing days are over, but it makes me sick for a variety of reasons to see kids who’ve just cut their teeth fed what those places serve because mom and dad are too lazy or tired to give the child a real breakfast, lunch, or dinner or too lenient to say, “No, no MacDonald’s.”
    Rant over.

    1. You know, you can still find articles that refer to the “heritable” nature of mental illnesses like schiz

      The absolutely STOOOPID notion that something common like Schiz was genetic was repeated so many times in the press that most of the public thinks it’s actually true. That one drives me nuts. Yeah sure there are probably susceptability genes but those exist for everything. Big deal. It’s like looking for the genes responsible for different modes of Calcium absorption in an effort to explain why people get broken bones. idiots. It’s no big deal to be wrong, I’m probably wrong all the time. But it’s another thing entirely to be a geneticist and completely unaware of the theory of natural selection.

  2. Drowssap and carole – I am really jazzed about the paradigm shift for understanding and treating mental health issues. I would like to keep the SSA discussion on the first thread on this issue where I specifically wonder aloud about that matter.
    I think it would be good to separate discussion of SSA cause and how mental health etiology might shift based on this paradigm. So on this thread, let’s keep the discussion on infection/pathogens and psychiatric issues. Thanks!

  3. Yes, the hypothesis that makes the most sense for such a pathogen is that it is a common pathogen, or one like the polio virus that stays in the gut, and as far as we know, does no harm to the gut tissues. In a very small %of people, it attacked the nerve sheathing. Maybe all it took was a small lesion in the stomach or intestinal wall to be carried to other places.
    Boy, as a kid during the polio epidemic, I was scared to death. I was frightened by all those pics of people in iron lungs, and there was a boy in the neighborhood who, we were told, never came out of the house because he had polio.
    It was terrific news when the oral vaccine came out. My whole town was assigned, by alphabetical order, a day to show up at the high school cafeteria to swallow that little paper cup of liquid.
    I was thinking about the parvo virus that affects dogs (because I was thinking about the evolutionary capabilities of such pathogens.)
    Pathogens either evolve to virulence or to benignity depending on what they need to do to reproduce.
    Here’s a viru, parvo, that has evolved superior capabilities. It kills the host and because it does, it has to find a way for replications of itself to stay alive so it has-the feces of the host. It is absolutely amazing that once an area –the carpet, the grass, concrete, whatever– is contaminated, the virus can last as long as a year or more through extreme cold and hot temperatures. Only bleach, lots of it, can kill it.
    Now it has evolved to variants and there are arguments as to whether it can or already has crossed the species barrier in a slightly different form to infect cats.
    As more and more dogs have been immunized by vaccination, it stood to reason that the virus would evolve another strategy to survive. Deadly bugger.

    1. My dad told me that parents used to be terrifed of Polio. In my generation (I was a teen in the 80s) it wasn’t even something we talked about. It was like black and white history book stuff. 😎 What a blessing.

      As for STDs, Herpes causes Cerebral Palsy. That right there should scare people to death. Odds are good that STDs are behind a lot of illness in children, maybe even things like Autism. Viral infections (especially Herpes) can cause high blood pressure during pregnancy. There is no telling how that might alter the physical and mental development of some children. When this stuff gets wiped out (and it will) there is no telling how much healthier we will be. It’s going to be a different world.

      As for bad and OVERplentiful high calorie food… eeeeee…. all you have to do is look around at the expanding waistlines of Americans. Who knows what else it might be doing to us. It’s certainly not natural to our species. Let me just brag for a moment that my wife and I are in our late 30s. We both weigh within 5 pounds or so of what we weighed in our early 20s. Thats a lot of exercise and salad… 😎

  4. Carole
    Nothing in all of mental health is more “genetic” than autism and even that cookie has completely crumbled.
    California’s Autism Increase Not Due To Better Counting, Diagnosis

    Published in the January 2009 issue of the journal Epidemiology, results from the study also suggest that research should shift from genetics to the host of chemicals and infectious microbes in the environment that are likely at the root of changes in the neurodevelopment of California’s children.

    The incidence of autism by age six in California has increased from fewer than nine in 10,000 for children born in 1990 to more than 44 in 10,000 for children born in 2000.

    I know that flu virus has been implicated in Autism but I wouldn’t be surprised if they ultimately find an STD or two is part of the picture too.

  5. Drowssap said,

    Perhaps it won’t be true and reptiles don’t carry any harmful pathogens that can harm children. It will be Interesting either way.

    I thought you were going to end your post by saying, “And now we know that they were right–that many of these carry things that cause illness in humans.” But you didn’t.
    But they DO–there are many things they carry and yes, we are not supposed to touch some of them and and that’s why many are no longer allowed to be imported.

    1. Wow, I didn’t even know that. So they do carry things. My dad grew up on a farm as did his dad in Europe. I don’t know how they figured it out but they knew at least 100 years ago that kids shouldn’t touch reptiles. Interesting.

      1. It’s been known for several decades that turtles carried salmonella. They even quit selling pet turtles in the USA in the 70s I think because of the risk to children.

        1. That one totally slipped by me. I guess I don’t do a lot of reading on food born illness, hehe. Maybe I should since Salmonella might actually affect me someday unlike most of the things I read about.

  6. Drowssap,
    Do you mean separate the lambs from the greater flock, not just from their mothers? After all, the more dense a population of people or of sheep, the less transmission probability of viruses and bacteria, and so yes, at least in that way they could see if any of those isolated lambs, once they reached “ramhood,” were disinterested in ewes. That seems simple enough, but then I know nothing about the care and feeding of sheep. (Surely they’ve done the simplest of things like checking the millk of the mother for pathogenic agents, right?)
    Then too, while isolation from the flock would cut down on their exposure to many things, what if this unknown hypothetical pathogen was vector transmitted? You’d have to control for that by putting them in an extremely controlled, almost sterile environment, wouldn’t you? For example, this bartonella, like so many other diseases, is transmitted by a fly. (BTW, the articles on the effects of lyme disease on people’s behavior remind me of this topic.)
    However, your larger point is on target–all of these things seem cheap and easy, and while they couldn’t identify anything, they’d go a long way to eliminating certain ideas. However, wouldn’t you think that R. and his team would have done such things by now? Perhaps they are doing them for all we know.
    Maybe because it’s so hard to identify stealth viruses, particularly when the virus (the trigger) is no longer active, they have limited themselves to looking at the trigger’s effects, the hormone production or lack of production, etc. Have they looked at neurotransmitters and receptors? Last I heard, GC felt they should look at neurotransmitters. I do know he was shaking his head over what he felt were wasted efforts, research that didn’t take into account or didn’t illustrate a knowledge of evolution (of either homo sapiens or pathogens).
    Also, consider how many pathogens are in the soil. In CA, it’s not uncommon to hear of people who come down with Valley Fever, a serious illness caused by a fungus that spreads through spores when soil is disturbed. Although I live in an area that doesn’t normally see cases of it, we had a neighbor who’d been down in the Central Valley, an agricultural area where it is more common, and by the time they diagnosed him, he was too far gone, and he died. This was over 20 years ago. They ran sputum culture after culture on him, and only when it was too late did they find it. At some point, his doctor suspected it from his symptoms (the fungus had affected his lungs–with others it can go to the brain), but they didn’t suspect it or get the evidence until it was much too late.
    To show how hard it is for even bacteriologists to identifiy things: My father had bad heart valves, and in the last 10 years of his life developed endocarditis three times. Treatment for that was 30 days of hospitalization with a penicillin drip. The first time he became ill, he went to the family physician and was given a broad based antibiotic for a low-grade fever. That explained why, when he was finally hospitalized because he grew sicker, they couldn’t grow a culture that showed anything. The initial antibiotics had made identification of it impossible and of course, with that serious an infection, they couldn’t afford not to start treating him with penicillin immediately so, as a result, they never did identify it.
    However, the next two times he become ill, the doctor immediately drew viles of blood before hospitalizing him and beginning the antibiotic treatment. He was handed over to specialists and a very well respected bacteriologist was added to the team and they NEVER were able to grow a culture that grew the pathogen! This occurred in the early to late 80s so maybe today, with their technologies, they’d be able to identify, but I wonder. So, if a bacterium that a doctor KNOWS is in that patient’s blood is sooooo hard to identify, imagine how difficult it is to find a virus especially if you don’t know what you are looking for.
    Furthermore, they could never figure out how my dad kept getting a bacteria into his circulatory system in the first place. No cuts, wounds, blisters…..nothing. The doctors were confounded as it had to enter the blood stream somehow. Finally, after the third time, I asked if ill-fitting dentures might not allow bacterial entry. Yep. My dad had always refused to go back to the dentist for new dentures. His were old and no longer fit properly. Of course, today people are warned about how very important good dental and gum health is to our overall health, but I don’t think a lot of people really understand that. Many infections, including those that may give rise to atheroscelosis (which my dad had) enter our systems through those gums. (They should advertise that on tv. It’s every bit as important as taking off alcohol and cigaretter ads.)
    I recall GC saying that maybe doing a lot of sample testing on blood, semen, saliva, and colo-rectal areas could tell them something (although it sounded lilke he kind of doubted this, as if he felt the intruder might be long gone, gone since childhood), but the problem with that according to those who’d do the research is that gay men as a group tend to have extraordinarily high infection rates and present with many pathogens, a situation that would make finding other things nearly impossible unless one had unlimited sources of money. It wouldn’t be an efficacious strategy in any case. I suppose they could try to get a sample of gay men who’d been celibate for a very long time.

    1. Sorry–

      After all, the more dense a population of people or of sheep, the less transmission probability

      I meant “the more dense a population…the greater transmission probability.”

    2. One problem is that whatever triggers homosexuality probably hits every single male in modern cities. It might not always hit at the right age or in the right amount but if 3% of men are gay it’s probably hitting everybody at some point. It’s a good bet that everyone makes antibodies against it. Complicating this is the fact that if it’s going to make someone gay it probably does this before the age of 3. After that it’s long gone. So you are right, figuring out what does this wouldn’t be easy.

      However HOORAH! we’ve got sheep to experiment on. All of the invasive testing that we can’t do on humans we can do on sheep. Seperating a sheep from it’s mom and the flock might only close some of the potential routes to infection but that has it’s upsides as well. For instance if simply removing a sheep from it’s mother prevented homosexuality BINGO scientists would know right where to look. It’s fairly likely that they’d have to test this concept in many ways and to differing degrees until they found a way that prevented infection.

      Oh yeah and Cochran’s simplest idea is to clone a gay sheep is gold. A straight clone from a gay sheep doesn’t prove his pathogenic theory. However it takes a wrecking ball to all the other major theories.

    3. ay men as a group tend to have extraordinarily high infection rates and present with many pathogens, a situation that would make finding other things nearly impossible

      You know the first group of men that acquired HIV and than AIDS did in fact often have multiple infections. However, lots of gay men are very healthy and have never had STDs. Certainly they could fill requirements for such a study from monogamous gay couples who are disease free. The way you make it sound like an impossiblity is frankly insulting.

      1. Patrick, that comment comes from an evolutionary biologist who stays in touch with researchers and the comment is not that old.
        There was no sarcasm intended, and I don’t see evidence of it. Is it possible you were looking for something where it didn’t exist?
        While safe sex practices have improved greatly for both the hetero and homosexual populations
        1.) It is not false to say that gay men have more sexual contacts than straight men, and that is especially true the younger they are. That , coupled with the lack of use of condoms with every single sexual contact, causes transmission of pathogens. Introduction of pathogens takes place with oral contact as well.
        2.) In addition, the lower colon and the rectum, lined with a thin layer of cells makes it particularly susceptible to infections of all kinds. Its biology and structure provide a fertile breeding ground for pathogens and for their entry into other tissues since that thin layer of cell are prone to lesions. Even a monogamous gay couple is likely to have exchanged pathogens if they have practiced anal sex since the rectum, unlike the heavily muscousal vagina, doesn’t have a shedding mechanism that works as the vagina does.
        Thus, celibate people would make the best candidates for use in a study sample. This would be true if we were trying to find out if something was sexually tranmissable in anyone–use a control group of people who haven’t had sexual contact to see if something is spread sexually or not.

        1. You know anal sex doesn’t create pathogens. If a couple is free of STDs remains monogamous – then they don’t magically create new pathogens.
          Certainly that group of gay men could be looked at if a disease free sample was needed.
          Perhaps I am too sensitive here – but it seemed like you were veering awfully close to the ‘gay men as disease ridden’ point of view (ala Cameron etc).

  7. And another zoonotic pathogen with behavioral ramifications is discovered–I read this one on several blogs over the last two days. This comes from Psychology Today

    Bartonella: It infects sheep, now humans
    By Pamela Weintraub on January 08, 2009 in Emerging Diseases
    I thought I would pass this on direct from North Carolina State University and the Centers for Disease Control and Prevention: Evidence of human infection with a species of bacteria most commonly found in sheep. Dr. Edward Breitschwerdt, professor of internal medicine at NC State’s College of Veterinary Medicine, and NC State colleague Dr. Ricardo Maggi isolated the bacterium Bartonella melophagi from samples of human blood.
    This is particularly relevant to psychologists because of the neuropsychiatric symptoms bartonella can induce –everything from increased anxiety and moodiness to trouble with cognition.
    Bartonella is already known to be spread by cats –and is often called Cat Scratch disease. Many believe there is strong evidence that bartonella species are spread, as well, by the same ticks that transmit Lyme disease.
    The bartonella reported in North Carolina — B. melophagi–is such a newly discovered member of the genus Bartonella it is considered a “Candidatus” species, meaning that its name has yet to be formally accepted. In nature, sheep are the most likely hosts for B. melophagi and transmission among sheep is thought to occur via a wingless fly known as a ked.
    The route of transmission to humans remains unknown.
    The results are published in the January edition of the CDC journal, Emerging Infectious Diseases.
    The blood samples Breitschwerdt and Maggi tested came from previously healthy women who were suffering from symptoms including muscle fatigue and weakness. One of the patients had been diagnosed with pericarditis, an inflammation of the membrane surrounding the heart. B. melophagi was present in blood samples from both women; Bartonella henselae, a strain of the bacterium which has been associated with human neurological illnesses and fatigue, was isolated from one of the samples.
    The research marks the first time that this particular strain of Bartonella has been cultured from human blood and associated with human illness.
    “Over the past decade, there has been a rapid expansion in the number of Bartonella species that are documented human pathogens,” Breitschwerdt says. “From this preliminary data, it looks as though we may be able to add another species to that list.”
    “A small number of Bartonella in the bloodstream can cause infection, and this fact, coupled with the large variety of transmission routes by which people can become infected, make the diagnosis, treatment and prevention of the illnesses a real challenge,” Maggi adds.
    Pamela Weintraub is senior editor at Discover Magazine and author of Cure Unknown: Inside the Lyme Epidemic, St. Martin’s Press, 2008

    1. WOW!
      That’s particularly relevant because only sheep and humans exhibit male, preferential homosexuality at any significant level. Is it a coincidence that we also happen to live in close proximity to each other? Of course not.

      Within a few years scientists somewhere will figure out that sheep are gay due to a pathogen. All they have to do is seperate 10 newborn lambs from their mothers and the rest of the flock. If they all turn out straight the pathogenic theory is confirmed. If that doesn’t work there are probably another dozen, cheap and effective ideas they can test to discover the mode of transmission. But whatever the mode somebody is going to figure this out and it won’t cost $100,000,000. If we don’t figure this out somebody in Asia will.

    2. While I was growing up my dad told me to never touch reptiles like turtles and lizards. He said they could make me sick. He never really explained what kind of sick only that he knew that it was bad. I got the feeling this was passed down to him from his dad who grew up near the Alps in Europe.

      I wonder if this type of “old wives tale” will eventually be born out by modern medicine. Ancient cultures figure something out and pass it down each generation. However they don’t know exactly why something is harmful so they just say, “don’t do this, it’s bad.”

      Perhaps it won’t be true and reptiles don’t carry any harmful pathogens that can harm children. It will be Interesting either way.

    1. The “group” mentioned in that GNXP link certainly does posess greater than average left handedness. They also tend to be shorter than average and have lower IQs than average. Put that together and it’s a dead giveaway that some type of disease set that ball in motion. I think those people should be put to death but in reality most (or all) of them are victims as well. Something chewed up their brains.

    2. The “group” mentioned in that GNXP link certainly does posess greater than average left handedness. They also tend to be shorter than average and have lower IQs than average. Put that together and it’s a dead giveaway that some type of disease set that ball in motion. I think those people should be put to death but in reality most (or all) of them are victims as well. Something chewed up their brains.

  8. Mind Germs, Pts. 1 and II–forgive me if I posted these links on another thread. I don’t think I did; I know I sent these to a friend so maybe that’s what is stuck in my head (perhaps the germs have had their way with me!)

    1. GOLD! The article is two years old and at least one “possibility” has been ultimately proven true. Schizophrenia is now strongly believed to be triggered by the immune response of the pregnant mother.

      This article mentions that 14% of Schiz comes from flu virus but I’ve seen other articles putting it over 20%!

  9. While research into PANDAS has been able to establish a definitive link between strep and sudden onset of odd behavior in children investigation into the effects of the borna virus has grown as well. The virus is a serious neurological disease of many animals and there are many who believe it is linked to at least some cases of bi-polar illness and other mental illness in humans. Google it and you’ll find lots of studies.

      1. BTW, I added that last part to my name in the hopes that I can get my share of the $700 Billion bailout. 😎

  10. Drowssap said,

    I guess thats more evidence that just because everyone is doing something doesn’t mean they aren’t crazy.

    HAHAHAHA. Precisely what GC said–people get used to things and think it’s the result of design, God’s, Nature’s or both! Having gotten used to it, they don’t think it’s the result of a dysfunction.

  11. Thanks for those sources, Drowssap, very interesing.
    When it comes to paraphilias, one does have to shake one’s head. It’s very easy to say, “Well, as long as it doesn’t hurt anyone (or anything!), but that doesn’t mean that something in the brain “ain’t reallllllly screwed up!” Furthermore, in many cases, it does hurt someone.
    It certainly would be nice for science to find out what that it is that causes such things because let’s face it–that WAS what was going on with Jeffry Dahmer and others whose paraphilias/ compulsions led to murder. Find out what causes such things and, boy, we will also have found out a great deal about criminal acts.
    Developmental problems in the womb? Outside the womb? Pathogen attack in the womb, outside the womb? Remains to be seen.

    1. Pretty much all (perhaps all) common development problems come back to some type of “insult.” Either a pathogen, pollution, radiation or something in the environment started the ball rolling. If it’s common it almost can’t be genetic.

      In some environments 100% of California Killfish are infected with Euhaplorchis californiensis which enters their brains and ultimately controls their behavior. I guess thats more evidence that just because everyone is doing something doesn’t mean they aren’t crazy. 😎

  12. Carole

    Though it is not known why, PANDAS patients overwhelmingly obsess about urination, which is not an especially dominant obsession in other OCD cases

    This has really got me thinking. If somebody would do a study on whether people with paraphilas (fetishes) have an increased incidence of left handedness we’ve got our answer. Increased left handedness over the average is a dead giveaway that fuses are being blown during development.

    This entire report is interesting but Chapter 2.2 might be the most relevant. It explains how bacterial meningitis can trigger left-handedness in children.
    Pathological left-handedness

    Fifteen percent were left-handed. Severity of childhood bacterial meningitis was related to lefthandedness (Odds Ratio (OR) 6.2, 95% CI 2.0 to 18.6 for those with a total severity score above the median compared to those below). Compared to non left-handed children, left-handed children had lower IQ (mean difference – 6.6, 95% CI -12 to -1.2), lower vocabulary score of WISC-r (-1.0, -2.1 to 0), and lower Beery score on visual-motor integration (– 4.9, -10.1 to 0.4). Left-handed children also had more combined academic and behavioural limitations (OR 2.7, 95% CI 0.9 to 8.6), lower manual speed of the dominant hand (mean difference -9 taps, p < 0.05) and better manual steadiness in the non-dominant hand (mean difference of contact’s time -2.7 second, p<0.05).
    Our results support the role of early life brain damage in left-handedness. Left-handed postmeningitic children generally have worse neurodevelopmental outcome than non left-handed survivors.

  13. The whole thing is fascinating, and it shouldn’t surprise us that anything affecting the brain would result in a behavior modification.
    We often wonder about compulsions, fetishes, etc. It certainly is not much of a stretch to see that someone with a permanent obsession or “fetish” (not that I am saying they are the same thing–I am speaking in layman’s terms here) may have a similar thing going on.

    Though it is not known why, PANDAS patients overwhelmingly obsess about urination, which is not an especially dominant obsession in other OCD cases

    1. BINGO! I was driving around today and that’s the exact sentence that stuck out for me.
      In the not too distant future we’ll have powerful vaccinations and other technologies like this that will wipe these pathogens out. I wonder if future generations will consider people from older generations as strange and quirky.

      1. They will remark about the filthy conditions we lived in and call our daily activities tedious and barbaric. And someday someone will comment about the ancient wisdom of writing a letter to a friend to promote good health.

  14. My computer is crazy this morning, so I’ll have to give the source of this in a follow-up post.

    (1). Brain imaging studies found that the caudate nucleus, frequently linked with OCD, became inflamed in PANDAS patients when antibody presence was high (2).
    OCD symptoms are generally very similar between children with PANDAS and other OCD patients (5). However, the onset of symptoms can be quite different. While OCD is usually first identified in adolescence, PANDAS patients are always prepubescent. This is likely to be because of the rarity of GABHS infections in teens and adults. Also, though OCD usually manifests itself gradually, in PANDAS patients it can set in overnight. Swedo and colleagues report frequently seeing children whose parents could recall the day their child became obsessive-compulsive (2). Though it is not known why, PANDAS patients overwhelmingly obsess about urination, which is not an especially dominant obsession in other OCD cases (5). The episodic pattern of symptoms is unique to PANDAS patients. While other OCD patients can go through periods where symptoms are slightly more or less exacerbated, PANDAS patients often experience complete disappearance of symptoms between episodes (1). It is unknown whether a genetic marker on B cells of the immune system known as D8/17 is specific to PANDAS patients, or common in all OCD patients (6). The structure and function of this marker is currently being identified, and may provide some clues about the heredity of PANDAS or OCD in general (2).
    Thus far, studies in which penicillin was given to PANDAS infected children as a preventative measure against strep and OCD have been inconclusive (3). However, many PANDAS patients have shown significant reduction of OCD symptoms when given plasmaphoresis, a type of plasma transfusion, to remove the antibodies (2). Current studies are further investigating prophylactic antibiotics, plasma exchange, and steroids as possible treatments to go along with SSRIs in treating both PANDAS and ordinary OCD.
    As in most cases of OCD, other neuropsychiatric disorders are often present in PANDAS patients. Swedo and colleagues found that 40% of PANDAS patients suffered from ADHD, 42% from affective disorders, and 32% from anxiety disorders (1). There are several points of interest in discussing the comorbidity of these illnesses with PANDAS. It was found that non-OCD psychiatric symptoms in most cases followed the same cycles as OCD symptoms, and set in suddenly when antibody levels were high (1). This brings up the question of whether any additional psychiatric disorders can be triggered by strep throat or other bacterial infections. Though there is no evidence to date linking post-strep autoimmune dysfunction with any illnesses other than tic disorders, OCD, and possibly late-onset ADHD, researchers are looking into possible ties with disorders like autism, anorexia, and depression (2). The comorbidity statistics also suggest that particular areas of the brain which we know are involved in other psychiatric disorders are attacked by the post-strep antibodies, and could help lead to identifying the exact cells or proteins that are targeted. Interestingly, the putamen and globus pallidus, neighbors of the caudate nucleus, are linked to tic disorders and hyperactivity (2). This could explain the frequency of occurrence of these symptoms alongside OCD in PANDAS.
    The frequency of PANDAS in the general population is unknown, but it is definitely a rare disorder. By contrast, OCD is present in one to two percent of the population (7). This may make PANDAS research appear useless in relation to research on “normal” OCD. On the contrary, the small size of the subgroup of PANDAS sufferers and the link to a disease as widely studied as strep throat could provide the key to discovering the cause of OCD and identifying exactly what genes and brain structures are involved (2). For example, if the nature of the antibody attack on the basal ganglia in PANDAS were identified, researchers could possibly target similar degradation in the basal ganglia of other OCD patients and potentially begin to look at ways to prevent this degradation. Also, research and public knowledge about PANDAS might make more people aware of the medical aspects and biological causes of mental illnesses. Perhaps this would lessen societal discrimination against the mentally ill and lead more people to understand why pharmaceuticals are often helpful or necessary in treating mental illnesses (7).
    There is strong evidence of a link between streptococcal infections and obsessive-compulsive disorder in some children. Though it is not known exactly how the immune system turns against itself and causes behavioral symptoms, there is hope within the scientific community that answering questions about PANDAS will in turn lead to answers about OCD and mental illness in general. This disorder provides evidence for medical models of psychiatric illnesses, and for the idea that the brain = behavior. It is amazing and frightening that an illness that seems like a mere nuisance can lead to a severe behavioral change almost overnight. However, research and possible treatments appear promising, and this tiny disorder may contribute more to the body of neuropsychiatric knowledge than any other illness in the past.

    1. I read every word of that, FASCINATING!!!
      Speaking of Co-Morbidity
      According to Dr. Siviero (not sure who that is)

      Siviero reports a high rate of both left eye preference and left hand preference in OCD, compared to dyslexia and controls.

      Increased rates of left handedness are a clear indication that a fuse was blown sometime during development.

  15. Lynn David – The age criterion is 3 to puberty primarily because the researchers wanted to delimit the subgroup of children for research purposes. It is not clear that the phenomenon occurs only during these ages. However, to your point, the developing brain would be more vulnerable it seems to an autoimmune attack. One hopes the damage is not permanent, but it is hard to rule out that possibility. I am a bit more hopeful given the plasticity of the brain in response to trauma. Other changes are more subtle. For instance, a child who manifests OCD or other symptoms probably alters his/her social world in such a way as to impact ongoing personality development and self-attributions.

  16. Would such cases normally occur only in the young with those perhaps who are greatest affected being the youngest? Or could it have something to do with a middle-aged youth. Time when a portion of the brain is being developed? Just spit-balling here…..

  17. For years researchers believed that mental illness had to be genetic. Then, they softened their language to “it has to have a genetic component,” then the equally ambiguous “multi-factoral.” This idea seemed to be supported by studies which found that things like depression, bi-polar disorder, schiz, etc. “ran in families.”
    However, while we’ve a long way to go in unraveling the mysteries of mental illness and those behaviors such as some panic disorders, compulsions, etc. that do not go so far as to incapacitate people and get termed as “mental illness,” let us not forget what the field of evolutionary biology and evolutionary medicine has been trying to get across and which is summed up by Ewald below:

    The fact that illnesses tend to run in families does not mean that only faulty genes are at work. Family members could just be passing each other pathogens.

    I think both Ewald and Cochran as well as R. Hamilton, before he died, suggested that when researchers call the cause of something “multi-factoral,” it’s a case of their not knowing what the heck causes it.
    So, as a consumer of information, I’d appreciate their saying, “We don’t know–yet.” Then, if they wish, they can add, “We are looking into x; then we’ll take a look at y, and then z.”
    Until they have proof, I’d just as soon not hear, “Well, it’s a complicated mix of x, y, and z, ” which is the “multi-factoral” pablum.
    It doesn’t bother me in the least if they admit, “We now have more questions than ever before.”

    1. Mental illness might strike some families particularly hard. But like you mentioned in a previous thread sinus infections can strike some families particularly hard. Sinus infections are caused by pathogens, not genes. A little bit of sinus infection isn’t passed down each generation. Genes merely make someone susceptible to particular pathogens or at least susceptible to a specific type of damage.

  18. What happened to Jonny is similar to what happened to me. I was convinced that if I didn’t do certain things over and over in perfect sequence that something awful would happen to my mom and/or my dad. I was embarrased to tell my parents about this . All I would tell my mom is that I “was worried.” (These rituals took place at night.) She took me to the doctor, our family physician, and he told her that I was a worrier and that”kids go through these stages.” He didn’t know about my OCD. Hey, I was about 7, but I knew it would make me sound screwy to tell adults about this. I didn’t even tell my best friend.
    As I said in another post, I had had a bad infection that left the doctor puzzled. He finally said I either had scarlet fever or something similar to it, whatever that meant. I just know I had a very high fever, but for the life of me, I can’t recall if this OCD stuff took place immediately following that. I know they were close in occurrence. I just wonder if it left behind some damage that 45-50 years later left me prone to panic attacks when I drive the freeway.
    Oh, Drowssap, another culprit in many things, they believe, is borno virus.
    And while maybe this sentence belongs in another thread, I think I’ll sneak it in since it’s short: as to the “hormonal causation” theory of SSA: such a theory hasn’t speculated on why hormones would be out of balance–I’ve heard it suggested that an infection could do that.

    1. That’s sad about the OCD. The good news is that Strep Throat is living on borrowed time.
      A female relative on my wife’s side suffered a severe meningitis infection when she was a teenager 40 years ago. She hovered near death for days and even hallucinated. All during her adult life she has suffered depression and has a ferocious snap temper. It makes me wonder if the two are connected.

  19. SUUUUuuuuper fascinating.
    It’s great that many kids have symptoms that last just a short period of time. However in some cases (assuming it’s the same thing) it appears something in the brain gets “zapped” and these fears/phobias last a lifetime.

    This sort of phenomenon makes me think about all the people that I’ve known who weren’t mentally ill but were just…. a little off. If an infection can severely disrupt brain chemistry in some people surely it might also push it just slightly out of balance in others.

    Example: For every soldier who dies in battle probably 5 or 10 suffer injuries.

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