Article Title: Association of Streptococcal Throat Infection with Mental Disorders

Journal Title: The Journal of the American Medical Association (JAMA)

Publication Year: 2017

Author(s): Orlovska et. Al

Study Description:

In the past, streptococcal infection has bene linked to an abrupt onset of the development of obsessive-compulsive disorder (OCD) and tic disorders; this was termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Associations between streptococcal infection and the development of OCD or tic disorder has been established in the past, however results from studies have been conflicting and PANDAS remains a controversial topic. This is a population-based cohort study that aimed to investigate the risk of mental disorders, especially OCD and tic disorders, after a streptococcal throat infection. The study is the largest to date. consisting of 1,067,743 children less than 18 years of age. 638,265 (about 60%) of the children received a streptococcal test, of which about 55% tested positive for strep at least once. The individuals were then followed for a period of up to 17 years for the development/diagnosis of any mental disorder.

Outcomes: The outcome studied was a diagnosis of any mental disorder, OCD or tic disorders.

Individuals with a positive strep test result had an 18% increased risk of any mental disorder, a 51% increased risk of OCD and a 35% increased risk of tic disorders in comparison to individuals who were not tested for strep.

However, findings also showed that individuals with a negative strep test who were presumed to have a non-strep throat infection also had an increased risk of mental disorders. Those with strep infection had a greater risk of any mental disorder and of OCD compared to those with a non-strep throat infection. After adjusting for confounders, the risk of OCD was 94% larger for those with a positive test result compared to those with a negative test result.

Conclusion: Individuals with a streptococcal throat infection and with a nonstreptococcal throat infection both had an increased risk of a mental disorder, OCD and tic disorder. The risk of all mental disorders and of OCD was greatest in those with streptococcal throat infection.

Limitations:

1. Used a proxy method to define positive streptococcal test result. For example, some individuals may not have undergone a strep test however were treated for strep based on clinical signs and symptoms, leading to misclassifications.
2. Only included individuals seen by hospitals, not private practices or general practitioners. 

Clinical Applicability:

This study can help guide clinical practice because It serves as the largest cohort study on PANDAS. PANDAS is currently still being researched and there are a lot of unknowns relating to this topic, however this study provides results that favor elements of PANDA. This study can help to enforce the need for additional future studies about this topic to help establish more information about this disorder.

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