Introductory Discussion on PANDAS, No, Not the Kind In the Zoo, and PANS

By August 31, 2017 Blogs

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is the sudden onset or worsening of Obsessive-Compulsive Disorder (OCD) and/or tic disorders in children and adolescents following a strep infection. Drs. Susan Swedo, Henrietta Leonard, and Judith Rapoport at the National Institute of Mental Health (NIMH) first discovered the connection between OCD and/or tic disorders and strep infections in the 90’s during their studies of childhood-onset OCD. In 2010, a new, broader term was defined to describe all cases of the sudden onset or worsening of childhood OCD and/or tic disorders, not just those brought on by a strep infection. This new term PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is to PANDAS as cancer is to breast cancer. PANS is the overall category and PANDAS is a specific type of PANS.

It is crucial for mental health providers to be able to identify suspected PANS/PANDAS cases because we are typically the first people these cases are referred to. Below are some of the most common symptoms/criteria:

  • Acute sudden onset/worsening of OCD symptoms/tics
  • Prepubertal onset
  • Challenges with eating, and in extreme cases, anorexia
  • Sensory sensitivities (e.g., clothes, sound, and light)
  • New onset of bedwetting and increased urinary frequency
  • Small motor skills deteriorate
  • ADHD symptoms and irritability
  • Overnight onset of anxiety or panic attacks
  • Separation anxiety
  • Developmental regression (e.g., temper tantrums, ‘baby talk’, and handwriting deterioration)

PANDAS/PANS are clinically diagnosed after a thorough assessment of the child’s history, lab tests, and a physical exam. Lab tests are necessary to determine if strep or other infections are present, however these tests alone do not warrant a diagnosis of PANS/PANDAS. A swift diagnosis allows medical providers to treat the infection quicker (e.g. antibiotics, plasmapheresis, intravenous immunoglobulin (IVIG), and steroids), which can significantly decrease the child’s neuropsychiatric symptoms. Neuropsychiatric symptoms can be treated using cognitive behavioral therapy (CBT), more specifically exposure and response prevention (ERP) and SSRI medication.
For a more in-depth discussion on PANDAS/PANS and parental support, see below resources:
https://www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/pdnb/web.shtml
http://www.pandasnetwork.org
https://kids.iocdf.org/what-is-ocd/pandas/
References:
Chang, K., Frankovich, J., Cooperstock, M., Cunnigham, M.W., Latimer, M.D., Williams, K., Walter, J., & Swedo, S.E. (2015) Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology, 25(1), 3-13. DOI: 10.1089/cap.2014.0084
https://kids.iocdf.org/what-is-ocd/pandas/
https://www.nimh.nih.gov/labs-at-nimh/research-areas/clinics-and-labs/pdnb/web.shtml
http://www.pandasnetwork.org