Altered frequencies of Th17 and Treg cells in children and adolescents with obsessive-compulsive disorder

Natalia Rodrígueza, Astrid Morerbgh, Azucena González-Navarrocg, Carles Serra-Pages, Daniel Bolo, Teresa Torrese, Albert Martinez-Pinteñoe, Sergi Ma, Amalia Lafuenteegh, Patricia Gassóeg, LuisaLázarobdgh
Brain, Behavior, and Immunity-2019

•Th17 cells are increased in children and adolescents with OCD.
•Percentages of Treg cells are reduced in OCD patients.
•Increased levels of Th17 cells are associated with higher severity of OCD symptoms.
•Increased levels of Th17 cells are associated with longer duration of disease.
•Reduced percentatges of Treg cells are associated with longer duration of disease.

Association of Streptococcal Throat Infection With Mental Disorders Testing Key Aspects of the PANDAS Hypothesis in a Nationwide Study

Sonja Orlovska, MD; Claus Høstrup Vestergaard, MS; Bodil Hammer Bech, PhD; Merete Nordentoft, DrMed; Mogens Vestergaard, PhD; Michael Eriksen Benros, PhD
JAMA Psychiatry-2017

The findings reported in this research study represent one of the largest retrospective studies conducted to date on the association between streptococcal infections and PANDAS. Children with a previously positive streptococcus test had an 18% higher risk of any mental disorder, 51% higher risk of OCD, and 35% higher risk of tic disorders, which are diagnostic criteria for PANDAS. Study findings support the association of streptococcal and non-streptococcal infections in the diagnosis of pediatric acute-onset neuropsychiatric syndrome.

A Pediatric Infectious Disease Perspective on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection and Pediatric Acute-Onset Neuropsychiatric Syndrome

Wald, Ellen
The Pediatric Infectious Disease Journal-2019

In 2013, a PANS Consensus Conference was convened at Stanford University, and several consensus statements have been published in recent years. The existence of PANDAS has been controversial from the time of its first publication. For those of us familiar with the sequelae of streptococcal disease and the concerns of community physicians faced with the care of children with these neuropsychiatric symptoms, the controversy has proven to be a disservice to both pediatricians and families. It has fostered a dismissive attitude toward important clinical observations.

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

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

Lauren Breithaupt, Ole Köhler-Forsberg, Janne Tidselbak Larsen
JAMA Psychiatry-2019

Findings: 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.
Meaning: The findings suggest that prior exposure to infections and treatment with anti-infective agents are associated with the development of eating disorders, supporting an emerging immunologic hypothesis.

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
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.

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. 

Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity

Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G Jr, Karpel H, Thienemann M.
J Psychiatr Res.-2019

Conclusions: Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.