Monthly Archives:
March 2019

Family Quality of Life When Raising a Child with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS)
Barbara B. Demchick, Julia Ehler, Shelly Marramar, Alison Mills & Amanda Nuneviller (2019) Family Quality of Life When Raising a Child with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS), Journal of Occupational Therapy, Schools, & Early Intervention, 12:2, 182-199, DOI: 10.1080/19411243.2019.1592052

“PANDAS is characterized by rapid onset of Obsessive Compulsive Disorder and/or tics following streptococcal infection in a previously healthy child. PANDAS is frequently misdiagnosed and misunderstood, which affects family quality of life (FQOL). A qualitative phenomenological design was used to examine FQOL in six families with a child with PANDAS. Data were collected through an audiotaped semi-structured interview and a phone interview to confirm findings. After rigorous data analysis, five themes emerged: Life Suddenly Turned Upside Down, My Child is Not Crazy, Emotional Distress within the Family, Major Life Alteration, and School Drastically Influences FQOL. Findings suggest that occupational performance and FQOL are severely restricted when a child has PANDAS. Implications for occupational therapy are discussed.”

Autoimmune Diseases and Psychotic Disorders

Rose Jeppesen, Michael Eriksen Benros
Frontiers in Psychiatry

The increasing knowledge on the potential involvement of inflammatory processes in mental disorders and the associations found between autoimmunity and psychotic disorders can help the expanding field of immuno-psychiatry and have impact on the outcome of patients. In the last couple of years, researchers have focused on the role of infections, autoantibodies and other immune components that plays a major role in autoimmune diseases. Potentially this might also be the case for mental disorders.

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome
Breitschwerdt EB, Greenberg R, Maggi RG, Mozayeni BR, Lewis A, Bradley JM. Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome. J Cent Nerv Syst Dis. 2019 Mar 18;11:1179573519832014. doi: 10.1177/1179573519832014. PMID: 30911227; PMCID: PMC6423671.

Methods: Evaluation of a 14-year-old boy with sudden-onset psychotic behavior. Bartonella spp. serology, PCR, DNA sequencing, and blood culture used for assessment. PCR assays for other vector-borne infections performed.

Results:

  • 18 months of psychosis despite multiple hospitalizations, psychiatric medications, and autoimmune encephalitis treatment.
  • Neurobartonellosis diagnosed after cutaneous lesions appeared. Bartonella henselae DNA found in blood despite doxycycline treatment. Negative B. henselae serology.
  • Combination antimicrobial chemotherapy led to symptom improvement, drug cessation, lesion resolution, and return to normal activities.

Conclusions: B. henselae bloodstream infection may contribute to persistent neuropsychiatric symptoms in a subset of PANS patients.

Treating pediatric acute-onset neuropsychiatric syndrome

Elizabeth Heavey; Kathleen Peterson
The Nurse Practitioner-2019

Pediatric acute-onset neuropsychiatric syndrome (PANS) can be caused by infectious and noninfectious triggers. NPs can help children with PANS recover from their symptoms and prevent future recurrences by appropriately screening, recognizing, and diagnosing the clinical presentation of PANS. PANS treatment includes pharmacologic therapies as well as cognitive behavioral therapy.

Paediatric acute-onset neuropsychiatric syndrome in children and adolescents: an observational cohort study

Johnson, Fernell, Preda, Wallin, Fasth, Gillberg, Gillberg.
Lancet Child Adolesc Health-2019

Excerpt: Of 41 patients (37 referred and four visited upon parents’ request), 23 (ten girls and 13 boys) met PANS diagnostic criteria. Mean age at PANS onset was 8·5 years (SD 3·37). 11 (48%) patients had a family history of developmental or neuropsychiatric disorders in a first-degree relative and 11 (48%) had a family history of autoimmune or inflammatory diseases in a first-degree relative. 

Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity

Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G Jr, Karpel H, Thienemann M.
J Psychiatr Res.-2019

Conclusions: Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.