Numerous studies have suggested that rheumatic ever may trigger psychiatric symptoms, particularly obsessive-compulsive disorder. In one study, an analytical cross-sectional study was conducted with a large sample of psychiatric outpatients at a Brazilian private practice over a period of 10 years. Of 678 subjects, 13 presented with a history of rheumatic fever, and these exhibited a notably higher prevalence of sub-clinical obsessive-compulsive spectrum traits when compared with those without a history of rheumatic fever.
Another study found an association of acute-phase rheumatic fever with obsessive-compulsive disorder, body dysmorphia and tic disorders. The researchers suggested that obsessive-compulsive spectrum disorders may share underlying biological pathways and vulnerability factors with RF, or that it is possible that RF triggers CNS manifestations of these disorders.
Yet another study found a correlation between both generalized anxiety disorder and obsessive-compulsive disorder in those who had suffered from rheumatic suffered:
“This was a case-control family study in which 98 probands and 389 first-degree relatives (FDRs) were assessed using structured psychiatric interviews. A Poisson regression model was used to determine whether the presence of any disorder in one family member influences the rate of disorders in the remaining family members…Generalized anxiety disorder (GAD) occurred more frequently in the FDRs of RF probands than in those of control probands (P=.018). The presence of RF, GAD, or separation anxiety disorder in one family member significantly increased the chance of OCSDs in another member of the family…We found familial aggregation among RF, GAD, and OCSDs. Clinicians should be aware of the possible familial relationship between GAD and OCSDs in their RF patients and their family members, which may suggest a genetic component between them. Further studies on OCD should include anxiety disorders to better define OCD spectrum.”
In another study, tic disorders, major depressive disorder and ADHD were found among those with both Sydenham’s chorea and rheumatic fever:
This study examined the frequency and age at onset of psychiatric disorders among children with rheumatic fever, Sydenham’s chorea, or both and a comparison group…Twenty children with rheumatic fever, 22 with Sydenham’s chorea, and 20 comparison children were assessed by means of a semistructured interview and rating scales for tic disorders and obsessive-compulsive disorder…Obsessive-compulsive symptoms were more frequent in both the Sydenham’s chorea and rheumatic fever groups than in the comparison group. The Sydenham’s chorea group had a higher frequency of major depressive disorder, tic disorders, and attention deficit hyperactivity disorder (ADHD) than both the comparison and rheumatic fever groups. ADHD symptoms were associated with a higher risk of developing Sydenham’s chorea…Both the rheumatic fever and Sydenham’s chorea groups were associated with a higher risk of developing neuropsychiatric disorders than the comparison group. ADHD appears to be a risk factor for Sydenham’s chorea in children with rheumatic fever.