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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.
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Mental Health Awareness Month

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Category:  Blog
Teacher Appreciation Week
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Teacher Appreciation Week

National Teacher Day is May 7, 2024, and National Teacher Appreciation Week is May 6-10, 2024 Teachers and schools, your dedication shines brightly. We appreciate those who have attended an ASPIRE...

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Category:  Blog
Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome
Jane E. Zebrack, Jaynelle Gao, Britta Verhey, Lu Tian, Christopher Stave, Bahare Farhadian, Meiqian Ma, Melissa Silverman, Yuhuan Xie, Paula Tran, Margo Thienemann, Jenny L. Wilson, Jennifer Frankovich,  Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome medRxiv 2024.04.26.24306193; doi: https://doi.org/10.1101/2024.04.26.24306193
  • 79.8% had at least one NSS-BG (neurological soft signs/behaviors).
  • Average of 2.1 NSS-BG per patient.
  • More NSS-BG = higher global impairment and more symptoms.
  • Regression Results:
    • NSS-BG correlated with global impairment and symptom count (p=0.045 and p=0.002, respectively).
    • No correlation with age or PANS duration at presentation.
  • Conclusions:
    • High NSS-BG prevalence in PANS.
    • NSS-BG linked to severity, not age.
    • Suggests targeted neurological exams could aid PANS diagnosis.