Monthly Archives:
May 2024

Two Cases of Montelukast-Associated Psychosis in Children
Jumaili WA, Gburi NA, Chaudhary N, Brown K, Jain S. Two Cases of Montelukast-Associated Psychosis in Children. Prim Care Companion CNS Disord. 2024 May 28;26(3):23cr03694. doi: 10.4088/PCC.23cr03694. PMID: 38815271.
In 2020, the FDA issued a black box warning of severe mental health complications in children associated with montelukast use.1,2 Montelukast-induced dose dependent neuropsychiatric symptoms in children include depression, anxiety, irritability, sleep disturbance, nightmares, agitation, suicidal behavior, auditory/visual hallucinations, and/or full psychosis.1 Stopping montelukast treatment abruptly can have varying effects on underlying neuropsychiatric symptoms and may increase the likelihood of recurrence after restarting montelukast.1
Montelukast treatment has been linked to an increased risk of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).5 The correlation between montelukast therapy and PANDAS is not fully understood, but many streptococcal infections have occurred after discontinuing montelukast treatment.5
Diagnosing and Treating Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections

O’Dor SL, Kuhn AJ, Williams KA, et al. Diagnosing and treating pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. Prim Care Companion CNS Disord. 2024;26(3):23f03662.  May 23, 2024. https://doi.org/10.4088/PCC.23f03662

  • Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a disorder of acute onset with obsessive-compulsive disorder and/or tics in children following a group A streptococcal infection, often with other behavioral or cognitive symptoms, including irritability and separation anxiety.
  • Symptoms of PANDAS overlap with those of many psychiatric and medical conditions; most children experience a relapsing and remitting course, and some have persistent difficulties that last through childhood and into their adolescence.
  • Since PANDAS is a diagnosis of exclusion, a thorough psychiatric and medical evaluation is necessary to make the correct diagnosis and institute appropriate treatment.
  • Treatment of PANDAS should involve a 3-pronged approach: psychiatric/behavioral treatment, immunomodulatory therapies, and antimicrobial treatment.