Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study

Raposo-Lima, C., Pereira, I.M., Marques, F. et al. Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study. BMC Psychiatry 21, 272 (2021). DOI: 10.1186/s12888-021-03289-w

“Although PANDAS might be of relevance for only a minor proportion of OCD cases, this immune/inflammation hypothesis may be significant given the prevalence of OCS among patients with autoimmune diseases [9]…. In conclusion, we herein report differences in NGAL levels among OCD patients compared to healthy controls. We offer additional evidence to the immune dysregulation hypothesis of OCD by reporting elevated levels of NGAL among OCD patients versus healthy controls, with higher differences being found among women”

Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

F Murgia, A Gagliana, MG Tanca, N Or-Geva, A Hendren, S Carucci, M Pintor, F Cera, F Cossu, S Sotgiu, L Atzori, A Zuddas. Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Frontiers in Neuroscience. Vol 15. 2021. DOI: 10.3389/fnins.2021.645267  

  • Found unique plasma metabolic profile in PANS patients that is significantly different from healthy children
  • Suggests involvement of specific patterns of neurotransmission (tryptophan, glycine, histamine/histidine)
  • Suggests a general state of neuroinflammation and oxidative stress (glutamine, 2-Hydroxybutyrate, and tryptophan-kynurenine pathway) in the disorder.
  • Offers new insights into biological mechanisms underpinning the disorder and supports research of other potential biomarkers implicated in PANS.
Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever

Ali A, Anugwom G O, Rehman U, et al. (May 12, 2021) Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever. Cureus 13(5): e14990. doi:10.7759/cureus.14990

Conclusions:  SC is a rare presentation of ARF. Without adequate treatment and supportive care, SC can cause severe functional impairment. ARF should be considered as a differential diagnosis in school-aged children presenting with choreiform movements. Chorea can be managed with antiepileptics and antipsychotics; however, evidence on IVIG use for chorea has also been reported. There is no international consensus on the standard choice of treatment; therefore, IVIG should be used in severe functional impairment when unresponsive to other therapies.

Paediatric Acute onset Neuropsychiatric Syndrome: Exploratory study finds no evidence of HLA class II association but high rate of autoimmunity in first‐degree relatives

Elisabeth Fernell, Mikael Sundin, Anders Fasth, Lisa Dinkler, Martyna Galazka, Christopher Gillberg, Mats Johnson Acta Paediatr. DOI: 10.1111/apa.15805

No HLA allele association such as seen in children with narcolepsy after H1N1 immunisation could be confirmed in this group of children with PANS. However, more than half the group had a first‐degree relative with a diagnosed autoimmune disease.

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SARS-CoV-2 related Paediatric Acute-onset Neuropsychiatric Syndrome

Piero Pavone, Manuela Ceccarelli, Silvia Marino, Daniela Caruso, Raffaele Falsaperla, Massimiliano Berretta, et al. Lancet Child Adolesc Health. 2021 . May 04, 2021 DOI:10.1016/S2352-4642(21)00135-8

“Post-infectious, autoimmune, and neuro-inflammatory events are the main mechanisms of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS).4 PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction.4 The estimated prevalence of OCD in childhood and adolescence is 0·25–4·00%, with those aged between 16–18 years (1%) having the highest prevalence.5, 6, 7 Here, we report on two unrelated children with PANS that started 2 weeks after a positive COVID-19 nasopharyngeal swab.”

  • Two young adolescents Diagnosed with COVID-19 by a nasal swab
  • PANS started 2 weeks after COVID-19 diagnosis
  • Had acute new OCD, neuropsychiatric, and motor dysfunction symptoms
  • SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS

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Obsessive-Compulsive Disorder With Rheumatological and Inflammatory Diseases: A Systematic Review

Alsheikh A M, Alsheikh M M (May 01, 2021) Obsessive-Compulsive Disorder With Rheumatological and Inflammatory Diseases: A Systematic Review. Cureus 13(5): e14791. doi:10.7759/cureus.14791

“Conclusions: Based on our findings, there is a strong correlation between OCD and different inflammatory as well as rheumatological biomarkers. Such correlations have been demonstrated in both adult and pediatric populations. Future studies should examine the safety and efficacy of anti-inflammatory medications, especially NSAIDs, for the management and control of OCD symptoms in both adults and children, particularly in the early stages of the disease.”

Inflammatory Neuropsychiatric Disorders and COVID-19 Neuroinflammation
Tang, S., Helmeste, D., & Leonard, B. (2021). Inflammatory Neuropsychiatric Disorders and COVID-19 Neuroinflammation. Acta Neuropsychiatrica, 1-55. doi:10.1017/neu.2021.13
Neuropsychiatric sequalae to COVID-19 infection are beginning to emerge, like previous Spanish influenza and SARS episodes. Streptococcal infection in pediatric patients causing OCD (PANDAS) is another recent example of an infection-based psychiatric disorder. Inflammation associated with neuropsychiatric disorders has been previously reported but there is no standard clinical management approach established. Part of the reason is that it is unclear what factors determine the specific neuronal vulnerability and the efficacy of anti-inflammatory treatment in neuroinflammation. The emerging COVID-19 data suggested that in the acute stage, wide-spread neuronal damage appears to be the result of abnormal and overactive immune responses and cytokine storm is associated with poor prognosis. It is still too early to know if there are long term specific neuronal or brain regional damages associated with COVID-19, resulting in distinct neuropsychiatric disorders. In several major psychiatric disorders where neuroinflammation is present, patients with abnormal inflammatory markers may also experience less than favorable response or treatment resistance when standard treatment is used alone. Evidence regarding the benefits of co-administered anti-inflammatory agents such as COX-2 inhibitor is encouraging in selected patients though may not benefit others. Disease modifying therapies are increasingly being applied to neuropsychiatric diseases characterized by abnormal or hyperreactive immune responses. Adjunct anti-inflammatory treatment may benefit selected patients and is definitely an important component of clinical management in the presence of neuroinflammation.
Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study

Kinderlehrer DA. Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study. Int Med Case Rep J. 2021;14:279-287

“Conclusion: There is increasing support for the role of infections in the genesis of AN in some patients. The data suggest that autoimmunity is playing a prominent role in the pathogenesis of microbial-induced AN, and that role has been elucidated in children and adolescents with PANS. This is the first documented case of Lyme borreliosis complicated by three co-infections triggering AN. This adds to the existing literature that infections can play a more prominent role in AN. The corollary is that physicians should become aware of this association in the evaluation of patients with AN, as it may provide a treatment option for this serious and sometimes fatal condition. The possibility that tick-borne infections could underlie the diagnosis of AN warrants further study.”

Clinical guidance for diagnosis and management of suspected Pediatric Acute‐onset Neuropsychiatric Syndrome in the Nordic countries
Pfeiffer HCV, Wickstrom R, Skov L, Sørensen CB, Sandvig I, Gjone IH, Ygberg S, de Visscher C, Idring Nordstrom S, Herner LB, Hesselmark E, Hedderly T, Lim M, Debes NM. Clinical guidance for diagnosis and management of suspected Pediatric Acute-onset Neuropsychiatric Syndrome in the Nordic countries. Acta Paediatr. 2021 Apr 13. doi: 10.1111/apa.15875. Epub ahead of print. PMID: 33848371.

“Consensus was achieved in the collaboration on work‐up and treatment of patients with paediatric acute‐onset neuropsychiatric syndrome, which we hope will improve and homogenise patient care and enable future collaborative research in the field.”

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Role of tonsillectomy and adenoidectomy in parental satisfaction of treatments for PANDAS

Navin Prasad, Stephanie Y. Johng, Daniel Powell, Matthew Williams, Elizabeth Latimer, Earl H. Harley, Role of tonsillectomy and adenoidectomy in parental satisfaction of treatments for PANDAS, American Journal of Otolaryngology, 2021, 102963, ISSN 0196-0709, DOI: 10.1016/j.amjoto.2021.102963.

“Caregivers reported a decreasing frequency of symptoms over time regardless of treatment and had no difference in satisfaction. T&A was the most preferred treatment and the most impactful on symptoms for surgical patients. Given the challenges of immunologic therapies, T&A in combination with antibiotics should be considered as an early intervention for PANDAS.”

Evaluation of Intravenous Immunoglobulin in Pediatric Acute-Onset Neuropsychiatric Syndrome
Isaac Melamed, Roger H. Kobayashi, Maeve O’Connor, Ai Lan Kobayashi, Andrew Schechterman, Melinda Heffron, Sharon Canterberry, Holly Miranda, and Nazia Rashid.Journal of Child and Adolescent Psychopharmacology. Feb 18, 20210 DOI: 10.1089/cap.2020.0100

Conclusions: In PANS, which may be associated with an underlying immune dysregulation, sequential infusions of IVIG [Octagam 5%] successfully ameliorated psychological symptoms and dysfunction, with sustained benefits for at least 8 weeks, and up to 46 weeks in a subset of subjects. In addition, baseline immune and autoimmune profiles demonstrated significant elevations in a majority of subjects, which requires further evaluation, characterization, and study to clarify the potential immune dysfunction by which PANS manifests and progresses.

Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis

Irina A. Vanzhula, Shruti S. Kinkel-Ram, Cheri A. Levinson. Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. Journal of Affective Disorders. Volume 283, 2021,p 302-309, DOI: 10.1016/j.jad.2021.01.083.


  • Difficulties controlling intrusive thoughts is a common symptom between eating disorders and OCD
  • Perfectionism symptoms bridge eating disorders and OCD
  • Restriction links to checking compulsions and rigidity
  • Binge eating links to hoarding symptoms

The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.