What to Do When You Worry Too Much guides children and parents through the cognitive-behavioral techniques most often used in the treatment of anxiety. Lively metaphors and humorous illustrations...
Sankaranarayanan, Anoop & John, J. (2003). Paediatric autoimmune neuropsychiatric disorders (PANDAS): A case report. The National medical journal of India. 16. 22-3. Read report
In view of the early onset of obsessive symptoms with periodic sudden exacerbations interspersed with periods of partial remissions, and the past history of streptococcal throat infection, the possibility of PANDAS was considered (Table I). However, he did not exhibit any abnormal movement, although he seemed fidgety and restless (Swedo2 has described ‘squirminess’ in some patients). In addition, the ASO titre done at our hospital was negative. It is, however, well accepted that not all exacerbations are preceded by group A beta-haemolytic streptococci (GABHS) infections and a prospective follow up is required to establish this association.
Note: Neither tics nor abnormal movements are required for a PANS diagnosis.
Sara M Bodner, Syed A Morshed, Bradley S Peterson, The question of PANDAS in adults, Biological Psychiatry, Volume 49, Issue 9, 2001, Pages 807-810, ISSN 0006-3223, https://doi.org/10.1016/S0006-3223(00)01127-6.
We describe an adult with onset of obsessive–compulsive disorder at 25 years of age after a severe antibiotic-responsive pharyngitis. He was evaluated with multiple psychiatric rating scales for obsessive–compulsive disorder and Tourette’s syndrome, as well as with serologic assays and radiologic studies.
Results: In all respects except age our patient fulfilled established criteria for PANDAS. Assays for antibodies to group A β-hematolytic streptococci, serum D8,17 lymphocytes, antistriatal (neuronal) antibodies, and anticytoskeletal antibodies all supported the hypothesis that a poststreptococcal process was active. Magnetic resonance imaging was abnormal and is described.
A review of clinical observations and literature reports leads to the hypothesis that, via a process analogous to Sydenham’s chorea, infections with group A β-hemolytic streptococci, among others, may trigger autoimmune responses that cause or exacerbate some cases of childhood-onset obsessive-compulsive disorder (OCD) or tic disorders (including Tourette’s syndrome).
Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64. doi: 10.1111/j.1749-6632.1988.tb31838.x. PMID: 3190104.
Patient Vignette – Bicycle Boy
The patient was bitten by a tic. Weeks later he presented with neuropsychiatric symptoms. Was given IV antibiotics and all symptoms resolved.
Results: The children’s symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean = 6.3 years, SD = 2.7, for tics; mean = 7.4 years, SD = 2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children; there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure.
Conclusions: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies.