Dissertation submitted to the University of the Witwatersrand, in partial fulfilment of an MSc in Child Health. Johannesburg 1997 / AC2017

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.