Tips for Accurate Mental Health Diagnosis: Four Unusual Clues to Consider

Part 3: Navigating medical conditions masquerading as primary psychopathology

Anthony D. Smith LMHC, Posted May 29, 2021

“Perhaps some of the most interesting cases of medical conditions disguised as psychological problems are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (PANDAS), and anti-NMDA encephalitis due to a teratoma.

  • PANDAS occurs in children who have had frequent strep infections. In people with PANDAS, for some reason, the strep infection does not just affect the throat, and may enter the brain. Antibodies rush in to fight it, not only destroying the bacteria, but also the brain tissue (Columbia University, 2015). This seems correlated with sudden onset of symptoms of aggression and impulsivity, vocal or motor tics like in Tourette’s Syndrome, and repetitious behaviors and obsessions as in OCD (Swedo et al., 2015; Thienemann et al., 2017). Thankfully antibiotics often help, and some get their tonsils removed as a long-term solution. In people with actual OCD or Tourettes, strep infections may exacerbate them.”

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