# OCD - Biological Cause Debate - New York Times 5/22



## Dreamer

This is a fascinating article, not just about OCD, but about the pitfalls of research. I personally believe OCD is a biological disorder. I know a number of folks with OCD, one my husband, who insists his disorder (lifelong for 61 years and misdiagnosed for years) is indeed biological.

The article is long, but worth a look. This is an old arguement, but whether or not strep causes OCD in SOME children isn't the point. I believe this research will eventually lead to greater understanding of the biological cause of many mental illnesses.

D

*The New York Times*

May 22, 2005

*Can You Catch Obsessive-Compulsive Disorder?
By LISA BELKIN*

*To suffer from obsessive-compulsive disorder, many patients say, 
is to ''know you are crazy.'' Other forms of psychosis may envelop 
the sufferers until they inhabit the delusion. Part of the torture 
of O.C.D. is, as patients describe it, watching as if from the 
outside as they act out their obsessions -- knowing that they are 
being irrational, but not being able to stop.* They describe 
thoughts crowding their minds, nattering at them incessantly -- 
anxious thoughts, sexual thoughts, violent thoughts, sometimes all 
at the same time. Is the front door locked? Are there germs on my 
hands? Am I a murderer if I step on an ant? And they describe 
increasingly elaborate rituals to assuage those thoughts -- 
checking and rechecking door locks, washing and rewashing hands, 
walking carefully, slowly and in bizarre patterns to avoid stepping 
on anything. They feel driven to do things they know make no sense.

*There are researchers who believe that some of this disturbing 
cacophony -- specifically a subset found only in children -- is 
caused by something familiar and common. They call it Pediatric 
Autoimmune Neuropsychiatric Disorders Associated With Streptococcal 
Infection, or, because every disease needs an acronym, Pandas. And 
they are certain it is brought on by strep throat -- or more 
specifically, by the antibodies created to fight strep throat.*

If they are right, it is a compelling breakthrough, a map of the 
link between bacteria and at least one subcategory of mental 
illness. And if bacteria can cause O.C.D., then an antibiotic might 
mitigate or prevent it -- a Promised Land of a concept to parents 
who have watched their children change overnight from exuberant, 
confident and familiar to doubt-ridden, fear-laden strangers.

Child psychiatrists have long known that sometimes O.C.D. in 
children can be like that, that it can come on fast, out of the 
blue, like a plague, and then last anywhere from days to months. If 
the typical graph of O.C.D. symptoms is a sine curve -- with 
episodes that ramp up slowly, peak gradually, then abate just as 
slowly -- the graph of rapid-onset O.C.D. is saw-toothed -- flat, 
then a sudden spike, followed by a relatively sharp drop, then flat 
again.

The patterns certainly look as if they could be two separate 
disorders, with similar symptoms but different causes. Across the 
country, many doctors are convinced of this and are putting young 
sudden-onset O.C.D. patients on long-term doses of antibiotics. 
''If I were to place bets,'' says Judith Rapoport, the child 
psychiatrist who first brought O.C.D. to public attention with her 
book ''The Boy Who Couldn't Stop Washing,'' that bet would be on 
the side of those who believe in Pandas.

But as certain as some researchers are, there are others, just 
as smart, with just as many impressive publications and titles, who 
think the theory is wrong or, at best, that it is too early to 
tell. And this group is warning that the Pandas hypothesis is 
misguided, perhaps even dangerous. ''Equivocal, controversial, 
unproven,'' Dr. Stanford Shulman, chief of infectious disease at 
Children's Memorial Hospital in Chicago, says of the theory.

*Pandas stands at a familiar, necessary and utterly frustrating 
moment in medicine -- in the gap between what doctors think and 
what they know. Practically every byte of scientific knowledge 
passes through a moment like this, on its way to being accepted as 
fact or dismissed as falsehood.*

It has always been so, but in recent years several things about the 
process have changed. Science now does its thinking in public, with 
each incremental advance readily available online. And those 
waiting for answers are less patient and more involved. They don't 
ask their doctors; they bring their own suggestions. They don't 
want to wait for the results of a two-year double-blind 
placebo-controlled clinical trial before they act. 
Which means that they often find themselves acting before all the 
facts are in.

Can strep bacteria cause obsessive-compulsive 
disorder? Do these children need penicillin or Prozac? Will we look 
back on these questions years from now and think, How could we have 
believed? Or, rather, How could we have doubted?

*The most vocal voice in support of Pandas is Susan E. Swedo, a 
pediatrician and researcher at the National Institute of Mental 
Health. She was the first to identify the syndrome, and the one who 
gave it a name. She has been studying the relationship between 
strep and O.C.D. for her entire career.*

She began her work in the 80's, a time of discovery in the world of 
obsessive-compulsive disorder. Although the disease had long been 
known, it was not until 20 years ago that researchers began to 
understand how prevalent it was and not until a decade later that 
they came to see how often it occurred in children.

In 1989, Rapoport published her best-selling book, taking the 
illness into the mainstream spotlight. When the television program 
''20/20'' ran a segment about her book, it prompted 250,000 calls 
from worried parents who thought they recognized their children. 
And a good number of them, Rapoport says, were right. *She 
estimates that more than one million children in the United States 
suffer from O.C.D. In fact, she argues, the disorder is one that 
often begins in childhood, which is why doctors should start 
looking for it then. Half of all adult O.C.D. patients look back 
and remember having repetitive thoughts and rituals when they were 
young, which is significantly higher than the percentage of adults 
with other psychiatric disorders who do. *

Rapoport strongly suspected that there was a medical model for 
at least some percentage of O.C.D. sufferers -- that the symptoms 
were not a result of emotional trauma (Freud's belief that it is 
caused by overly strict toilet training had long since fallen out 
of favor) but rather were caused by a biological trigger. She and 
her research fellows at the N.I.M.H. spent several years looking 
into it. Swedo was one of those fellows.

*Research had already shown that O.C.D. symptoms appear when 
there is damage to the basal ganglia, which is a cluster of neurons 
in the brain that acts as a gatekeeper for movement, thought and 
emotion.* ''So we set out to find every known condition that 
involved abnormalities of the basal ganglia,'' Swedo remembers.

Huntington's disease was one. Parkinson's was another. Also on 
the list was Sydenham's chorea -- a movement disorder known to 
medicine since before the Middle Ages, when it was called Saint 
Vitus' dance. About 70 percent of patients who develop Sydenham's 
also develop O.C.D. Sydenham's is caused by rheumatic fever; 
rheumatic fever is in turn caused by Group A beta-hemolytic 
streptococcal bacteria. In other words, strep throat.[/b]

The biological cascade from strep to Sydenham's starts when the 
body, thinking it is fighting the infection, begins to fight itself 
in a process known as molecular mimicry. The protein sheath that 
coats each invading bacterium cell is remarkably similar to the one 
that coats the native cells that form a particular part of the 
body. In this case, the protein code on the strep bacteria is a 
close match with the code on the cells in the basal ganglia. So the 
antibodies mistake the basal ganglia for strep and attack. This, of 
course, will not happen to every child who has strep throat, or 
even to most children, in the same way that every child who gets 
strep does not get rheumatic fever. ''It's the wrong germ in the 
wrong child at the wrong time,'' says Swedo, who suspects that some 
children are genetically predisposed toward Pandas.

By the mid-90's, Swedo had graduated to her own research laboratory 
at the National Institute of Mental Health. Back then the status of 
her research looked like this: *O.C.D., she knew, could be caused 
by damage to the basal ganglia. Sydenham's, too, was a result of 
such damage. Strep, by all accounts, was the cause of the damage in 
Sydenham's patients. Sydenham's patients often developed O.C.D. 
Given all that, the next logical question seemed obvious: Can strep 
cause O.C.D.?*

Swedo turned her attention anew to that *subgroup of patients who 
developed their symptoms seemingly overnight.* She and her 
collaborators hypothesized that this difference in onset could be 
the key to something important, a separate category, a 
differentiating wrinkle in a familiar pattern. *It might not be 
the key to decoding the cause of all O.C.D., but it might explain 
some percentage of cases.*

Swedo and her researchers put out a request among those who treat 
and suffer from O.C.D., looking for subjects -- children whose 
symptoms had come on suddenly. They received hundreds of calls and 
then determined that 109 of those children could accurately be 
described as having had a rapid onset of symptoms. The stories the 
parents told, while different in their particulars, were remarkably 
similar at their core. *The symptoms came on so quickly that most 
parents could tell you the exact date that their children's 
personalities changed. All these children woke up one morning, in 
the words of one parent, ''full-blown somebody else.''*

The exact nature of the obsessions and compulsions differed from 
child to child (a fact that makes all O.C.D. tricky to diagnose). 
Some could not stop washing their hands or insisting they needed to 
use the toilet or checking to make sure that doors were closed and 
locked. Some developed overwhelming separation anxiety or worried 
that they would harm someone or do something wrong. 
Some had one cluster of these symptoms during their first episode 
and a different set of symptoms the next time around. Nearly half 
complained of joint pain, but not always of a sore throat. They 
were fidgety and moody and obstinate. They had ''bad thoughts,'' 
some sexual, some violent, some frightening, that they could not 
get out of their heads.

The children were then tested for evidence that they had recently 
had strep -- either via throat culture, which would find active 
infection, or by a blood test that measures antibodies remaining 
after the actual infection is gone, or, when the episode was too 
long ago for either test to be effective, researchers asked about a 
remembered history of strep. In a striking percentage of cases, the 
search for strep came up positive.

*Disagreement is what propels all of science. Proof and disproof 
seems almost a requirement on the road to consensus.* 
Copernicus's theory that the planets revolve around the sun was not 
fully accepted until long after his death. Pythagoras and Aristotle 
each suggested that the world was round, but the idea was not 
widely accepted for many centuries. Dr. Ignaz Semmelweis was mocked 
and ostracized for suggesting that by simply washing their hands, 
doctors could prevent women from dying during childbirth. It would 
be another quarter-century before Louis Pasteur and Joseph Lister 
confirmed that destroying germs stops the spread of disease. Much 
more recently, doctors were exuberant when brain surgery seemed to 
halt the progression of Parkinson's disease and bone-marrow 
transplants seemed to beat back breast cancer. But the excitement 
dimmed as further study found the initial data to be overly 
optimistic. Perhaps most significant to the discussion of Pandas, 
strep has been proposed as the cause of a number of conditions over 
the years, including Kawaski disease, but subsequent studies have 
repudiated the theories.

''The history of medicine is full of these examples,'' says Dr. 
Barron Lerner, a medical historian at Columbia University Medical 
Center, describing fact later shown to be quackery, flights of 
fancy that turn out to be fact and many ideas that bounce for 
decades in the shades of gray between the two. ''What looks like 
it's there sometimes turns out not to be there,'' Lerner says, 
''and what everybody is sure of sometimes turns out not to be 
certain.''

*Swedo and her collaborators published several small preliminary 
studies during the late 90's, and their first major paper claiming 
that Pandas was a separate syndrome appeared in 1998 in The 
American Journal of Psychiatry. Called ''Pediatric Autoimmune 
Neuropsychiatric Disorders Associated With Streptococcal 
Infections: Clinical Description of the First 50 Cases,'' it is 
exactly that, a description of children who develop O.C.D. after 
exposure to Type A strep.*

In a way, the description is a tautology -- Pandas is classified as 
O.C.D. associated with strep, and therefore the only children who 
qualify for the diagnosis are those who have had recent strep. 
Swedo took the 109 rapid-onset cases and narrowed those to 50 that 
met her Pandas criteria, which means that 59 cases were triggered 
by something other than strep throat. She considers the results 
important, because at nearly 50 percent, the incidence of strep is 
far higher than would be expected in the general population and 
therefore statistically significant. But she agrees that her 
findings do not explain the cause of all O.C.D., or even all 
rapid-onset O.C.D.

*Despite the details still up in the air, the existence of Pandas 
was compelling to many doctors. They saw it as inherently logical, 
and it gave a name to some otherwise mysterious cases that passed 
through their waiting rooms. ''There is no doubt in my mind,'' says 
Tamar Chansky, a child psychologist specializing in childhood 
anxiety disorders and the author of ''Freeing Your Child From 
Obsessive Compulsive Disorder,'' which devotes a long section to 
recognizing Pandas.

Not only is it real, says Chansky, who treats several patients who 
suffer from the disorder, but she has also noticed that each 
episode is often worse than the one before, creating the 
possibility that unless these children are treated prophylactically 
for strep, their O.C.D. episodes could be longer, more intense and 
more frequent.*

''Yes, it is controversial, but I believe it is real,'' agrees 
Dr. Azra Sehic, a pediatrician in Kingston, Pa. One of the first 
times Sehic encountered Pandas was when she saw it in one of her 
patients, Maury Cronauer. Just before Memorial Day in 2003, when 
she was 6, Maury became ill with strep throat. She was treated with 
antibiotics and one morning soon after started acting ''odd,'' says 
her mother, Michelle, who is a nurse. A girl who never worried much 
about germs, Maury started washing her hands constantly, the most 
common symptom of O.C.D.

By the next day she was hysterical, saying horrid thoughts were in 
her head. She wasn't sure she loved her parents. She thought she 
was going to cheat at school or steal something. She wanted the 
racing thoughts to go away, and at one point her parents found her 
curled in a ball in the laundry room, her eyes crammed shut and her 
hands over her ears.

Sehic mentioned to Maury's parents that the strep might be the 
cause of her symptoms. She prescribed a longer course of 
antibiotics, to eliminate any lingering strep bacteria, which might 
signal the body to create more antibodies.

*The O.C.D. went away. A year and a half later, Maury got strep 
throat again, and the O.C.D. symptoms returned. She is now taking 
prophylactic penicillin, an approach that is also controversial. 
''It is not proven that it will help her, but it is likely that it 
will, so we are trying,'' Sehic says. *

As Pandas was becoming widely known, and as doctors began using 
antibiotics as a first salvo against obsession, there was ever more 
research under way. Swedo was a co-author of 30 journal articles 
between 1998 and 2005. Across the country other lab groups took up 
the subject as well, and there are dozens more publications in 
which Swedo played no role.

Some of these merely confirmed the existence of the subgroup Swedo 
had described. Other studies were designed to take knowledge of 
Pandas to the next level -- from description to proof. What Swedo 
had done was identify a group in which two things were true: O.C.D. 
developed suddenly, and the children had evidence of recent strep.

But that does not prove that the strep caused the O.C.D. Nearly all 
of science is a search for cause and effect -- that A made B 
happen, that C made B stop.

*The bane of all science is coincidence. For example, a notable 
percentage of children develop their first signs of autism soon 
after a vaccination, and it is tempting to blame the shot for the 
symptoms. But autism as a rule tends to show itself during the 
years when children are also scheduled to receive fairly regular 
immunizations. So the odds are good that the two events will be 
temporally linked.

Separating correlation from causation is where every research road 
becomes bumpy. ''It's been more complicated to follow up on this 
than we ever thought it was going to be,'' Rapoport says. 
There have been studies with results that were remarkably clear-cut 
-- the plasmapheresis trials, for instance. Plasmapheresis, also 
known as therapeutic plasma exchange, is essentially a cleansing of 
the blood, somewhat like dialysis. If strep antibodies were 
responsible for O.C.D. symptoms in Pandas patients, Swedo 
theorized, then clearing those antibodies from the bloodstream 
should prompt improvement.*

Because the procedure is so invasive, the only subjects enrolled 
were those in the worst shape. Of the 29 children in the trial, 10 
received plasma exchange, 9 received intravenous immunoglobulin and 
10 received a placebo. According to the results published in the 
journal Lancet in 1999, the children receiving plasma exchange 
became markedly better, while those receiving placebo treatment did 
not.

Other studies had results that were somewhat murkier. One tested 
the theory that you could prevent Pandas by preventing strep. 
Simply treating strep does not prevent the onset of Pandas since 
the antibodies have already had a chance to form, which leaves 
prophylaxis as the most promising form of treatment. That is one 
way strep was first proved to cause rheumatic fever. When patients 
who had had rheumatic fever were given daily antibiotics, they did 
not get strep and they did not get a recurrence of rheumatic fever. 
Similarly, the hypothesis went, if strep causes Pandas, then 
preventing patients from getting strep would also prevent a 
recurrence of an episode of Pandas.

So Swedo conducted a prophylaxis study. Half of a group of Pandas 
patients was put on daily doses of prophylactic antibiotics, while 
the other half was given a placebo. After several months, the 
placebo and antibiotic groups were switched. If prophylaxis works, 
then patients should have developed more, and more intense, 
episodes of O.C.D. while they were taking the placebo than while 
taking the antibiotics.

But the antibiotic chosen for this particular study was a liquid, 
and unlike the case with pills, which can be counted, it was 
difficult for parents to keep track of whether a dose had been 
missed. Even one missed dose would leave a child vulnerable to 
strep, and some children in the antibiotic group did get sick. A 
percentage of those developed Pandas.

At the same time, when children in the placebo group became ill, 
their parents figured out that what they had been dispensing was 
sugar water and, fearing that the sore throat would lead to a 
return of Pandas, went and got a prescription for penicillin. Not 
nearly as many of the control group got strep or Pandas as had been 
predicted.

''A lot was learned about parental behavior,'' Swedo says, ''but 
not a lot about Pandas.''

*Roger Kurlan, a professor of neurology at the University of 
Rochester School of Medicine and Dentistry, is not a man who minces 
words. ''The only thing that's a proven fact about Pandas,'' he 
says, ''is that children with these symptoms have been observed.'' 
Everything else, most specifically the role of strep in causing the 
symptoms, ''is nothing but speculation.''*

Kurlan and his collaborator Edward L. Kaplan, an expert in strep at 
the University of Minnesota Medical School, have become Swedo's 
most vocal critics. They describe strep and O.C.D. as two things 
that are ''true, true and unrelated.'' Yes, it is true that some 
children develop rapid-onset O.C.D. And yes, it is true that a high 
percentage of those test positive for strep. But that does not mean 
that the former is caused by the latter.

''In the prior two weeks, 90 percent of these kids might also have 
eaten pizza,'' Kurlan says. ''Can I make an association that pizza 
is linked to O.C.D.?''

''If 100 kids fall out of a tree and break their arms and we test 
them for strep, there's going to be a very high percentage of 
children who have evidence of recent infection,'' echoes Stanford 
Shulman of Children's Memorial Hospital in Chicago. ''That doesn't 
mean strep is the reason they fell out of the tree.''

*A more likely explanation for the presence of strep in children 
with Pandas, these doctors say, is that any infection, in fact any 
type of stress, can cause spikes in O.C.D. behavior. And they cite 
as an example children with Tourette's syndrome, who frequently 
have O.C.D. symptoms that ebb and flow with stress. 
Children with neurological disorders ''are sensitive to any number 
of things,'' Kurlan says. ''If their dog dies. If their parents are 
fighting. I've seen O.C.D. get worse with a cold, with hay fever, 
with pneumonia. If there is anything special about strep, I don't 
think anyone has been able to find it.''*

Yes, some children appear to develop symptoms more suddenly than 
others, he says, but that could be because they have hidden their 
earlier symptoms from their parents, which O.C.D. patients are 
known to do. And, yes, he agrees, patients often improve after a 
positive strep test and a regimen of antibiotics. But because 
O.C.D. is cyclical, odds are that they would have improved without 
the test and the medicine anyway. Add to that the fact that some 
children are strep carriers. They will test positive for the 
bacteria any time they happen to be cultured, further skewing the 
cause-and-effect relationship that Swedo is trying to prove.

Kurlan says that he understands why the idea of a bacterial cause 
for disturbing behavior is attractive to parents. A germ can be 
cured. A germ is not the parents' fault. ''It's a convenient 
link,'' he says, ''but it's very difficult to show a connection.'' 
Assigning blame where none exists can be dangerous, Kurlan says.

Part of the harm is that of commission -- giving unnecessary 
medication. Patients like Maury Cronauer, he says, who take 
penicillin every day to prevent strep in the first place, are 
making themselves vulnerable to drug allergies and are promoting 
antibiotic resistance. And he disagrees with Swedo's view that 
plasmapheresis can be the answer for the most severely affected 
patients. The procedure leaves children vulnerable to serious 
infection, he says, which he considers too high a risk given that 
the symptoms will arguably run their course over time.

A more insidious form of harm, however, is that of omission. While 
turning to antibiotics to cure their child's Pandas, parents might 
be ignoring other treatments that could alleviate what skeptics 
believe the child actually has -- plain old O.C.D. It may come on 
slowly or gradually, in the presence of strep or not; whatever the 
details, a child who cannot stop washing her hands needs to be 
treated with one of the many drugs and behavioral-therapy regimens 
that are successful in battling O.C.D., he says.

*''If families are distracted by a simple answer and are 
therefore not tackling the more serious issues, that would be a 
disservice,'' Kurlan says. ''Worse, that would be bad medicine.'' 
Individuals are not statistics, and their stories are not proof. 
But as I met families and heard their tales, I came to more deeply 
understand why Swedo is so certain of her theory and Kurlan is so 
wary of it.*

One 10-year-old girl in New Jersey, for instance, illustrates the 
hazy, sometimes illusory, difference between Pandas and O.C.D. The 
girl's mother (who asked that her name not be used to protect her 
daughter's privacy) describes two distinct times, at age 4 and age 
8, when her bubbly child became riddled with disturbing thoughts: 
''My mouth is full of cavities'' or ''The waiter put poison in my 
soda.''

The first time, the mother says, her daughter's doctors were 
uncertain of the cause. But the mother, after doing her own 
research and suspecting that it might be Pandas, called the 
N.I.M.H. Someone there confirmed her suspicions. Soon after, the 
girl took antibiotics, and, her mother says, the symptoms went away 
in seven months. The second time it took almost a year. The girl 
has had behavioral therapy but is not taking any medication for 
O.C.D. because her mother does not think it is necessary. The one 
precaution the family takes is keeping a supply of rapid strep test 
kits in the house and using them regularly.

Learning that her daughter had Pandas saved her own sanity, the 
woman says. ''It was like drowning in the middle of the ocean, and 
you grab onto something that will help you float.'' 
And yet. The second of the girl's two episodes, the mother says, 
was not brought on by strep but by a virus. By Swedo's definition, 
this would mean that the child did not have Pandas; that her 
parents think otherwise, Kurlan would argue, shows the danger of a 
bacterial scapegoat. The mother says that whatever caused the 
outbreaks -- strep infection, viral infection -- all that matters 
is that, at the moment, her daughter is fine. But when I ask the 
girl when she last had her bad thoughts, she tells me, ''Last 
week.''

*Another story of another child, however, shows the damage that 
can be done if parents start with a psychological rather than a 
physical assumption. (These parents also didn't want their names 
used to protect their daughter's privacy.) This little girl was 6 
last May, when according to her parents, she changed overnight, 
becoming clingy and asking the same question over and over and over 
and over again.

Her mother was pregnant at the time, and a psychiatrist her parents 
knew suggested that their daughter feared the arrival of her new 
sibling and was looking for attention. So first her parents 
reassured her. Then they began to punish her, sending her to her 
room so she could ''think about her behavior and change it,'' her 
mother says.

No one in the family, not even the girl's father, himself a doctor, 
linked any of this behavior to the raging strep infection she had 
three weeks earlier. They kept punishing her, and she kept 
insisting that she didn't want to act this way. ''Please stop 
punishing me for something I can't help,'' the mother recalls her 
daughter begging.

The parents took her back to the pediatrician's office (they had 
already been there three times), where they were given a 
prescription for an antidepressant. Instead of having it filled, 
they took her to a pediatric psychiatrist, who asked, ''Has she 
been sick with a sore throat?'' Blood tests showed that her level 
of strep antibodies was twice as high as it should have been. Two 
months later, after several weeks of antibiotics and several 
sessions with Tamar Chansky for cognitive behavioral therapy, the 
little girl was acting like her old self again.*

From where Roger Kurlan and other doubters sit, the situation 
looks simple. The theory of Pandas, they say, has not been proved. 
Until the causal link to strep is made, these children simply have 
O.C.D., and anyone who thinks differently is fooling himself. From 
where Swedo and her supporters sit, things look equally simple. 
They agree that cause and effect has not yet been definitively 
proved. But they are adamant that what has been proved so far is 
too significant to be ignored and that further research is more 
than warranted.

In the interim, they argue, logic dictates that any child who 
develops full-blown O.C.D. seemingly overnight should be given a 
throat culture or a strep-antibody test before she is sent to a 
psychiatrist. ''I'm all for empirical stringency,'' Chansky says, 
''but in the meantime, there's something so basic that can be done.

We're talking about a throat culture and maybe a blood test. What 
is the downside?''

The downside, Kurlan says, is that science is not supposed to 
guess. ''We would be testing children as if the results had meaning 
for their treatment,'' he says, ''and there is insufficient 
evidence that it does.''

Swedo is still looking for that evidence. Her most recent 
publication, in the April 2005 issue of Biological Psychiatry, 
describes a new study of prophylactic antibiotics, one in which 
administration of the medication was more closely controlled. The 
results: Those who received the antibiotics saw ''significant 
decreases'' in strep infections and in ''neuropsychiatric 
exacerbations'' over the course of a year.

Kurlan, in turn, is conducting research of his own, a nationwide 
study of 80 patients -- half with a history of O.C.D. that meets 
the Pandas criteria and half with O.C.D. that does not. For two 
years, researchers have been logging the rates of strep and the 
episodes of O.C.D. in each group. If strep causes Pandas, then 
O.C.D. symptoms should be intensified in the Pandas group relative 
to their exposure to strep, while in the control group a variety of 
system-stressing triggers should cause a spike in symptoms.

*When the data are compiled and made public later this year, the 
findings may prove that Swedo is wrong. Or they may instead prove 
that she is right. Most likely, this latest research will simply 
lead to more research, as science accumulates its evidence one bit 
of data at a time.*

*Lisa Belkin is a contributing writer for the magazine. Her last 
article was about Thomas Ellenson, a special-needs child in a 
mainstream school.*

*Copyright 2005 The New York Times Company*


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## Homeskooled

Dreamer, thats a brilliant, brilliant article. You know what the funny thing is? I had OCD growing up, and horrid, horrid strep throat about 3 times. My little brother has something like OCD, so I'm sending this article to my parents. We were a big family, and when one person got sick, all 7 of us did. We had strep throat "epidemics" in my house many times.

Peace
Homeskooled


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## Homeskooled

Dreamer, 
Have they done research on pandas in adults yet? I imagine it would cause the same, but the adult neurons probably are protected a bit more. Let me know. Thanks.

Peace
Homeskooled


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## Dreamer

Dear Homeskooled,
How be?

It is my understanding that the study of PANDAS is directed at a subset of young children who do develop this very soon after becoming ill. *The article also fails to mention, typical media reporting, that it is a VERY particular form of strep that needs a very specific antibiotic.*

If you go to PubMed... or you have access to many of these journals, yes? You can get more info on PANDAS.

There are many theories on schizophrenia, autism, etc. being caused by a number of biological enviornmental factors _as well as predisposition I'd say_ that can lead to mental illnesses.

I am convinced that many mental illnesses are indeed biological. That doesn't mean that the psychological doesn't interact/exacerbate, and therapy is as critical as anything else.

There is a ton of info out there on understanding mental illness in a medical, neurological way. I am pretty much convince that certain SYMPTOMS in particular are caused by a failure in some part of brain function.

I believe also in Ramachandran's theories that some illensses are the disruption/exagerration of evolutionary adaptation. It is known that some birds are hoarders! Some compulsively bring beads and other useless items back to their nests.

People see me here as a biological reductionist. I don't like that as I do realize the clear importance of therapy in all mental illness to help one cope. It can also greatly improve quality of life.

If you plug PANDAS or OCD into PubMed, you'll find a number of abstracts. Also, reading V.S. Ramachandran's work is absolutely fascinating.

Interesting that you had strep and OCD. The thing to remember is this is a SUBTYPE of OCD. But here's the deal... OCD doesn't come out of the blue. It is my understanding that these traits DO originate in childhood. Again I know a number of people whose OCD can be traced back to childhood.

Also, I have some "perfectionistic compulsions". I had them in childhood. I can't say those are/were attributed to strep. *And again, this is a particular strain which the article fails to mention.. I think... I need to reread it.*

Best,
D 8) 
Writing today, is keeping me from taking a nap again. I sleep far too much, but there is light at the end of the packing/moving tunnel. Someone took my old futon sofa. I'm gonna get me a REAL sofa when I move. Yeeeee HAAAAAA. I deserve one damnit. :mrgreen: 
Life is short and full of scary stuff. One day at a time.


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## Homeskooled

Dear Dreamer, 
You know, for all the journal and abstract reading I do, I've never accessed pubmed. Do you have to pay for that? I'm curious to know if a prophylaxis against strep can help adult OCD. Honestly, my dad seems to have it, and he caught strep right along with us. True, I think he had some religiously obsessive tendencies growing up, but the article says that it can exacerbate it in certain sub-types of people. My dad, actually, changed overnight when I was about 9, and became quite obsessive about things. It coincided with one of the "epidemics" in our house as well, and of course, my little brother has also contracted it. If part of it is genetics which are then triggered by an antibody reaction, a familial pattern would make sense. I'm not doing to well lately, but I'm not going to complain. Had alot of stomach pains this week, probably heading to the ER this afternoon, actually. Yeah, futons are great. The house we live in is pre-furnished, and it came with a large black leather sofa. I've slept all night on that. Its soooo comfortable. I try not to get in the habit of taking naps though. I read a study, though, that a nap in the afternoon is good for the brain, but I also think it can make one a little lazy, too. I dont get as much done when I do that. How's the move going? Get a job at Michigan U yet? And how's the new apartment?

Peace
Homeskooled


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## Dreamer

Homeskooled said:


> You know, for all the journal and abstract reading I do, I've never accessed pubmed. Do you have to pay for that?


I use PubMed for free simply to look up article abstracts. I have "secret friends" who go to uni who will sometimes send me full articles, or I can go to a uni and find them myself. I used to do this a LOT at UCLA when I lived in CA.

Abstract searches are free. It costs to purchase stuff. But it is a great way to collect articles for research in a decent library.



> I'm curious to know if a prophylaxis against strep can help adult OCD.


I doubt it. From my understanding of the work with PANDAS, the P is for "pediatric". The argument in the article above is in those cases where a child seems clearly predisposed to getting OCD symptoms after a certain type of strep throat.(the article failed to mention that :roll: it's a particular strain of strep).

If an adult has OCD, I'd say the "window of opportunity" for treatment has passed. And again PANDAS is a childhood disorder that triggers? apparently a very distinct subtype of OCD.



> Honestly, *my dad seems to have it, and he caught strep right along with us. True, I think he had some religiously obsessive tendencies growing up, but the article says that it can exacerbate it in certain sub-types of people.* My dad, actually, changed overnight when I was about 9, and became quite obsessive about things. It coincided with one of the "epidemics" in our house as well, and of course, my little brother has also contracted it. If part of it is genetics which are then triggered by an antibody reaction, a familial pattern would make sense.


Interesting re: your father. I'd say, if your father has OCD of any type, or OC tendencies, those would have been there before the strep throat. Again the cases of PANDAS are specific to children who have exhibited no OCD at all, get this particular strain of strep, and "change overnight." Quite stunning. I did see at least 2 documentaries on this. One might have been the 20/20 show mentioned in the NYT article.

My bet however is there seems to be familial patterns of mental illness. As I said, these things don't come out of a clear blue sky. Bi-polar seems to have a strong inherited component. OCD possibly, etc. My father had OCD and anxiety. I have anxiety and really have never been diagnosed as OCD, I'm not, (though I have "perfectionistic" traits -- moreso in childhood).

I feel I inherited some of both parents' genetic legacy for anxiety, depression, and even borderline? Who knows. I have Borderline traits, again much more in the past (helped by therapy and mood stabilizer Lamictal).

If your father's OCD seemed to get worse after the endless strep attacks -- man childhood is one long cold and sore throat, LOL, may be purely coincidence. Perhaps it exacerbated problems he had. I can't answer that as I don't know him at all, don't know the circumstances, etc. But I believe mental illnesses can be inherited and/or tendencies towards mental illnesses or predispositions that may or not manifest themselves.



> I'm not doing to well lately, but I'm not going to complain. Had alot of stomach pains this week, probably heading to the ER this afternoon, actually. Yeah, futons are great. The house we live in is pre-furnished, and it came with a large black leather sofa. I've slept all night on that. Its soooo comfortable. I try not to get in the habit of taking naps though. I read a study, though, that a nap in the afternoon is good for the brain, but I also think it can make one a little lazy, too. I dont get as much done when I do that. How's the move going? Get a job at Michigan U yet? And how's the new apartment?


Good grief man, please feel better. You're having such a rough time.

My move is on June 3 -- so SOON!, and at that point ONE THING AT A TIME. My first "job" is PT volunteer work at the local NAMI. Excellent chapter in a uni town. Need to get my sea legs back, but will be able to do a lot of different things. I may get a clearer sense of what specific jobs I can handle at the hospital or the uni itself.

There is also the possiblity of a paid position down the road. That would be COOL to work FOR NAMI! We'll see.

I've been an exhausted WRECK the past few months. THings are calming down again.

I have to get back to my Zen mindset. VERY difficult. More exercise is helping. Wearing myself out, makes me too tired to be anxious, and it indeed DOES give me more energy. Then of course there are those days I hide in bed........ cough......... sigh........ :shock:

Take care of yourself.
Cheers. Keep us posted. I'll be crabbing no doubt that I can't get my computer to work when I move, LOL. Will post from a library. I CAN'T WAIT TO GET SETTLED!

D 8)


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## Guest

OCD shows similar features with religious practices , rather than expressing things , persons that make stress upon you , that disturbs you you prefer repression and try to create a world of your own like Christian other world or humanism in this world . Some Nietzsche would be appliable here . I am not sure we should discuss it here , why the particular person with OCD shows particular practicess , particular thoughts , why he is caused to feel guilty , and the period following that and should be taken into consideration biological factors as well . But i do not think Biology is something apart from others . there ought to be a perspective that is unifying , that is avoiding specialization and that is true subjective perspective . Objective science that is based only on specialization sets limits . It would turn out to be good on the hands of good person who knows how to put them into application to gain time when doctors give randevous with limited times and when they put their heads into books that keeping them away from their subjectivity , the books that causing them not to see what is standing just in front of their nose where there is naked truth .


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