Monthly Archives:
February 2021

Role of tonsillectomy and adenoidectomy in parental satisfaction of treatments for PANDAS

Navin Prasad, Stephanie Y. Johng, Daniel Powell, Matthew Williams, Elizabeth Latimer, Earl H. Harley, Role of tonsillectomy and adenoidectomy in parental satisfaction of treatments for PANDAS, American Journal of Otolaryngology, 2021, 102963, ISSN 0196-0709, DOI: 10.1016/j.amjoto.2021.102963.

“Caregivers reported a decreasing frequency of symptoms over time regardless of treatment and had no difference in satisfaction. T&A was the most preferred treatment and the most impactful on symptoms for surgical patients. Given the challenges of immunologic therapies, T&A in combination with antibiotics should be considered as an early intervention for PANDAS.”

Evaluation of Intravenous Immunoglobulin in Pediatric Acute-Onset Neuropsychiatric Syndrome
Isaac Melamed, Roger H. Kobayashi, Maeve O’Connor, Ai Lan Kobayashi, Andrew Schechterman, Melinda Heffron, Sharon Canterberry, Holly Miranda, and Nazia Rashid.Journal of Child and Adolescent Psychopharmacology. Feb 18, 20210 DOI: 10.1089/cap.2020.0100

Conclusions: In PANS, which may be associated with an underlying immune dysregulation, sequential infusions of IVIG [Octagam 5%] successfully ameliorated psychological symptoms and dysfunction, with sustained benefits for at least 8 weeks, and up to 46 weeks in a subset of subjects. In addition, baseline immune and autoimmune profiles demonstrated significant elevations in a majority of subjects, which requires further evaluation, characterization, and study to clarify the potential immune dysfunction by which PANS manifests and progresses.

Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis

Irina A. Vanzhula, Shruti S. Kinkel-Ram, Cheri A. Levinson. Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. Journal of Affective Disorders. Volume 283, 2021,p 302-309, DOI: 10.1016/j.jad.2021.01.083.

Highlights

  • Difficulties controlling intrusive thoughts is a common symptom between eating disorders and OCD
  • Perfectionism symptoms bridge eating disorders and OCD
  • Restriction links to checking compulsions and rigidity
  • Binge eating links to hoarding symptoms

Conclusions
The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.

 

Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics

Margo Thienemann, Michelle Park, Avis Chan, Jennifer Frankovich. Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics. Journal of Psychiatric Research, Vol 135, 2021, PP 270-278. DOI: 10.1016/j.jpsychires.2021.01.022.

  • More than half of patients with PANS require psychotropic medication.
  • Side effects requiring a therapy change are common.
  • Drug doses at which side effects occur are usually less than recommended.
  • Clinicians should start with lower doses of psychotropics in PANS patients.

“Antidepressants’ most common side effects were anxiety, agitation, aggression, and akathisia. Antipsychotics’ most common side effects were dystonia, aggression, self-injurious behavior, and movement abnormality. Side effects were common at doses lower than the suggested starting doses for these medications. Patients tolerated antidepressants and antipsychotics when doses were low.”

Pediatric Acute-Onset Neuropsychiatric Syndrome with Capgras Syndrome
Sharawat IK, Panda PK, Gupta R. Pediatric Acute-Onset Neuropsychiatric Syndrome with Capgras Syndrome. Ann Indian Acad Neurol. 2021;24(4):600-601. doi:10.4103/aian.AIAN_959_20
This is believed to be the first reported case of Capgras syndrome in a child with PANS. A 9-year-old girl developed an acute onset of OCD behaviors, anorexia and emotional lability. Capgras syndrome is characterized by a specific monothematic delusion in which the patient believes that his/her relatives have been substituted by impostors who bear a close resemblance with the originals.
  • 3 weeks before symptoms, had acute pharyngotonsillitis, positive for strep.
  • Five days into the illness- increase in abnormal behavior and refused to recognize parents. Said they were replaced by some imposters and they are trying to hurt her.
  • Treated with Augmentin – OCD reduced in severity, appetite improved, started to acknowledge parents
Authors conclude: “Clinicians need to be aware of this rare monothematic delusion, as complete resolution can be achieved with timely treatment.”
Tetracyclines for COVID-19 Neurological and Neuropsychiatric Manifestations to treat Neuroinflammation

Tetracyclines for COVID-19 Neurological and Neuropsychiatric Manifestations to treat Neuroinflammation

Highlights

  • Neuropsychiatric symptoms were reported during COVID-19.
  • Coronaviruses have neuroinvasive potential and induce a potent neuroinflammatory response.
  • Tetracyclines can counteract neuroinflammation caused by neurotrophic viruses.
  • Tetracyclines interact with viral proteins presenting antiviral effects.
  • Tetracyclines represent a potential treatment for COVID-19 neuropsychiatric symptoms.

Chaves Filho, A.J.M., Gonçalves, F., Mottin, M. et al. Repurposing of Tetracyclines for COVID-19 Neurological and Neuropsychiatric Manifestations: A Valid Option to Control SARS-CoV-2-Associated Neuroinflammation?. J Neuroimmune Pharmacol (2021). https://doi.org/10.1007/s11481-021-09986-3

PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery

Cross Amy, Bouboulis Denis, Shimasaki Craig, Jones Charles Ray. Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Frontiers in Psychiatry. Vol 12, 2021. DOI:10.3389/fpsyt.2021.505941  

The subject of this case report had a concomitant diagnosis of Lyme borreliosis and PANDAS, both of which are consistent with the neuropsychiatric symptoms she experienced. As evidenced by her recovery and resolution of symptoms, treating both the Lyme infection and streptococcal infection, as well as treating the underlying autoimmune etiology of her neuropsychiatric symptoms resulted in a successful outcome. This case report and treatment history reiterates the complex and challenging nature of infection-triggered autoimmune neuropsychiatric disorders such as PANDAS and PANS and that multiple concomitant infectious agents can frequently be identified in patients suffering from these complex neuropsychiatric disorders. The presence of elevated antineuronal antibodies identified by the Cunningham Panel™ provided an aid in the diagnosis and in directing immunomodulatory treatment. The post-treatment resolution of these autoantibodies provided pathophysiological support for addressing both the infection(s) and the underlying immune system dysfunction which resulted in a positive medical outcome for this patient.

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