Neuropsychiatric profiles of children with Sydenham's Chorea in West Scotland

Sydenham’s chorea (SC): a post-streptococcal neuropsychiatric disorder, the most common cause of chorea in children worldwide but rare in Europe, may be the only manifestation of acute rheumatic fever. Descriptions of symptoms at SC onset, relapses, lifetime prevalence of developmental and psychiatric disorders and services used were obtained from children and their parents in West Scotland Liaison Psychiatry and Paediatric Neurology services over a three-year period. Interviews established medical and family history of physical and psychiatric symptoms, alongside a semi-structured, psychiatric interview (KSADS- PL), exploring current and most severe past episode of psychopathology. Twelve children, 7 girls, 5 boys, interviewed, age 10–15. Findings: six pre-existing neuro-developmental problems, four pre-morbid separation difficulties; debilitating conditions at onset included wheelchair requirements, speech impairments joint pain and psychiatric disorder. Psychopathology most severe during first episode but 6/12 reported SC relapses. Diagnoses identified: separation anxiety generalised anxiety ADHD, tics, ASD, psychosis). Educational problems were frequent. SC diagnosis was sometimes delayed. Services used: cardiology, rheumatology, physiotherapy, occupational therapy, speech therapy. Medication: long-term penicillin sodium valproate also various psychotropics. SC complicated by psychiatric symptoms may be associated with pre-existing vulnerabilities and can present clinical challenges for paediatric and mental health services.