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Biology 103
2003 Third Paper
On Serendip

Obsessive Compulsive Disorders, Obsessive Compulsive Spectrum Disorders, and the P.A.N.D.A.S. Connection

Elizabeth Bryan

As someone who's been plagued by an Obsessive Compulsive Spectrum Disorder since childhood, I can say it seems hopeless at times. For so long a sufferer feels that what they have isn't a legitimate ailment and that he is alone in his battle. Thankfully, in recent years, more and more research is being done on Obsessive Compulsive Disorders, and more answers are being found.

Obsessive Compulsive Disorders are the fourth most common psychiatric diagnosis. Sometimes the onset of symptoms is sudden, but more often than not it is a gradual progression. Precipitating events that could spur the onset of an Obsessive Compulsive Disorder can include emotional stress (domestic or job-related), increased levels of responsibility, health problems, and bereavement. According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, "the essential features of an Obsessive Compulsive Disorder are recurrent obsession or compulsions that are severe enough to be time consuming (i.e.: they take more than an hour per day) or cause marked distress or significant impairment. At some point during the course of the disorder, the person has recognized the obsessions or compulsions are excessive or unreasonable. It's important to note that this is difficult concerning children because children tend to not realize that their compulsions are excessive or unreasonable while adults do ((1) .).

People develop compulsions by trying to ignore thoughts or impulses, or by trying to neutralize them with other thoughts or actions. Compulsions are mental acts, and include repeating words, ordering things, hand washing, and various other motions. The goal of these compulsions is to prevent or reduce anxiety.

Because Selective Serotonin Reuptake Inhibitors (SSRI's) such as Prozac, Luvox, Zoloft, and Paxil are effective in controlling Obsessive Compulsive Disorders, it's believed that serotonin regulation is a part of the cause of OCD. Serotonin is a very important chemical messenger in the brain, and plays a role in a person's mood, aggression, impulse control, sleep, appetite, body temperature, and pain. Brain imaging studies have depicted various abnormalities in parts of the brains of Obsessive Compulsive Disorder sufferers. These parts include the caudate nucleus, the basil ganglia, the thalamus, orbital cortex, and cingulated gyrus.

Disorders that have the obsessive compulsive symptoms of intrusive, repetitive behaviors are often called OC Spectrum Disorders. Amongst these include Trichotillomania, Monosyruptomatic Hypochondriasis, Body Dismorphic Disorder, and some eating disorders. Other disorders also coexist with Obsessive Compulsive Disorders, and are referred to as Comorbid Disorders. The most common Comorbid Disorder is depression.

Trichotillomania is the chronic, repetitive pulling of bodily hair, most often being from the scalp, eyebrows, eyelashes, and pubic areas. Sufferers feel great anxiety before pulling, and feel a sense of relief after pulling out their hair. While more research needs to be done on Trichotillomania, it is believed to be related to abnormalities in brain function.

Body Dismorphic Disorder is "characterized by preoccupation with a minor bodily defect or imagined defect which is believed to be conspicuous to others" (Pedrick, #1). Repetitive Body Dismorphic Disorder behaviors include mirror checking, grooming, shaving, washing, skin picking, weight lifting, and comparing self with others. Both Trichotillmania and Body Dismorphic Disorder can be treated with medication and cognitive behavior therapy.

It is now widely believed that in many cases Obsessive Compulsive Disorders are triggered by a phenomenon called "P.A.N.D.A.S", or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. This term is used to describe children who have Obsessive Compulsive/"Tic" disorders (such as Tourette's Syndrome) in which symptoms worsen after a strep infection(2) ..

It's recently been found that in some children, the natural antibodies developed in their blood to fight a strep infection not only attacked the strep, but also attacked perfectly healthy cells as well, including the basal ganglia region, which controls the body's motor movements, and it also known to have abnormalities in OCD sufferers. Generally the onset of tics or compulsions is abrupt in P.A.N.D.A.S. cases, and may occur within days, weeks, or months following a strep infection.

Dr. Susan Swedo has been the most prolific researcher of P.A.N.D.A.S., and is the head of the Behavioral Pediatrics Department of the child psychiatry branch of the National Institute of Mental Health. Her department has been studying OCDs and their links to strep infections since 1986. According to Dr. Swedo, if the following criteria are met, a diagnosis of P.A.N.D.A.S. may be made:

1. "The presence of an OCD or tic disorder
2. Pediatric onset of symptoms (age three to pre puberty)
3. Abrupt onset or dramatic exacerbation of symptoms
4. Symptom exacerbation related to a strep infection
5. Neurological abnormalities during the exacerbation periods, which could include unwarranted fears, fidgeting, and difficulty in school" (2) .

Dr. Swedo also notes that if P.A.N.D.A.S. hasn't occurred by age twelve or thirteen, it most likely never will.

New treatments are being experimented with for P.A.N.D.A.S. In 1999, Dr Swedo reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry that plasmapheresis was successful in treating P.A.N.D.A.S. Dr. Swedo cited a preliminary study in which twenty-eight children were randomly assigned to receive plasmapheresis, intravenous immunoglobulin, or a placebo infusion. Tics declined fifty percent within one month in the plasmapheresis patients and twenty-five percent in the patients who received the immunoglobulin. No change was seen in the placebo group. Obsessive Compulsive Disorder symptoms were reduced by sixty percent with plasmapheresis, by forty-five percent with immunoglobulin, and virtually not at all with the placebo infusion(3) ..

Children treated with plasmapheresis showed greater improvement on global functioning measures, and their total improvement went on for over a month after their treatment. In the children who received the plasmapheresis, brain structures such as the caudate nucleus, basal ganglia, and globus pallidus, which are enlarged during P.A.N.D.A.S. flares, normalized. Dr. Swedo even said in some cases the difference in the size of the caudate nucleus is visible(3) ..

Thankfully, for OCD, OC Spectrum Disorders, and P.A.N.D.A.S. sufferers, more research is being completed everyday. Because significant research has only begun since the late 1980s, what is known now will be considered little in the years to come. The Plasmapheresis treatments now being experimented with look very promising in treating P.A.N.D.A.S. In terms of other OCDs, OC Spectrum Disorders, and Comorbid Disorders, cognitive therapy as well as medications have proved to be very effective. In my own experience with an OC Spectrum Disorder and depression, the combination of the right serotonin medication and therapy have proved very successful in allowing me to go on with my life without worrying about such disorders on a daily basis, as sufferers of these disorders often do.



1)What Causes OCD

2)Not Just a Sore Throat: Common Childhood Infection May Trigger Neurological Disorder

3)Strep Related OCD/Tic Treatment Info

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