ABSTRACT
This chapter presents a case of a 10-year-old boy who is brought to the general practitioner (GP) by his father. His father describes that his son has developed facial grimacing and tics 6 weeks ago having not had them before this. It is taking him longer to get ready for school and at bedtime, apparently because he is following routines and repeating them. The infection at the outset of this boy's problems may be important, since this young person has no history of these problems. This is a rare autoimmune-mediated response to group A beta-haemolytic streptococcal infection that is associated with pharyngitis following acute onset of obsessions and compulsions and/or tics with relapsing and remitting symptoms including emotional lability, anxiety, ritualized behaviours, oppositional behaviours and sometimes movement problems such as overactivity or lethargy. In the first instance some cognitive behavioural treatment would be appropriate with follow-up. If this is ineffective then a serotonin reuptake inhibitor should be considered.
