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Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report
Guido CA, Zicari AM, Duse M, Spalice A. Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report. Ital J Pediatr. 2019 Jun 26;45(1):74. doi: 10.1186/s13052-019-0667-1. PMID: 31242942; PMCID: PMC6595549.
Conclusions: Following eight sessions of EMDR, preceded by training sessions with the parents, the child showed a significant reduction in symptoms and disappearance of the exacerbation. These results indicate the possibility of improving the treatment outcomes of patients with PANDAS by a combined approach using both antibiotic and EMDR therapies.
Clinical-Serological Characterization and Treatment Outcome of a Large Cohort of Italian Children with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection and Pediatric Acute Neuropsychiatric Syndrome

Gemma Lepri, Donato Rigante, Silvia Bellando Randone, Antonella Meini, Alessandra Ferrari, Giusyda Tarantino, Madeleine W. Cunningham,Fernanda Falcini
JCAP-2019

Our study has confirmed the usefulness of the preliminary diagnostic criteria for PANDAS and PANS, revealing also the importance of early diagnosis to reduce the risk of evolution toward disabling chronic neurologic sequelae. Long-term antibiotic prophylaxis has resulted in a substantial benefit to reduce neurological symptoms for the majority of PANDAS and PANS patients over a 7-year period.

Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls
Breithaupt L, Köhler-Forsberg O, Larsen JT, Benros ME, Thornton LM, Bulik CM, Petersen L. Association of Exposure to Infections in Childhood With Risk of Eating Disorders in Adolescent Girls. JAMA Psychiatry. 2019 Aug 1;76(8):800-809. doi: 10.1001/jamapsychiatry.2019.0297. Erratum in: JAMA Psychiatry. 2019 May 8;: PMID: 31017632; PMCID: PMC6487907.

In a Danish population-based cohort study of 525 643 adolescent girls, a prior infection in childhood was associated with an increased risk of later anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders.

Immunoneuropsychiatry: novel perspectives on brain disorders

Katrin Pape, Ryad Tamouza, Marion Leboyer & Frauke Zipp 
Nature Reviews Neurology-2019

  • Chronic inflammation and latent infections can cause higher-order network disturbances, resulting in cognitive and behavioural impairment.
  • Psychosocial stress correlates with inflammatory processes in the CNS.
  • Immune dysregulation plays a key role in psychiatric disorders
  • Immune treatments are emerging as therapeutic options
A minority of children diagnosed with Lyme disease recall a preceding tick bite
Nigrovic LE, Neville DN, Balamuth F, Bennett JE, Levas MN, Garro AC; for Pedi Lyme Net. A minority of children diagnosed with Lyme disease recall a preceding tick bite. Ticks Tick Borne Dis. 2019 Apr;10(3):694-696. doi: 10.1016/j.ttbdis.2019.02.015. Epub 2019 Feb 26. PMID: 30853264.

Out of 1770 children evaluated in the emergency department for Lyme disease, 362 (20.5%) were diagnosed with the condition. Among those with a documented tick bite history, only a small percentage (18.5%, 95% confidence interval 14.6-23.0%) of Lyme disease cases were associated with a recognized tick bite. Therefore, the absence of a tick bite history does not reliably rule out Lyme disease.

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.