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Psychiatry

Margo Thienemann, Michelle Park, Avis Chan, Jennifer Frankovich. Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics. Journal of Psychiatric Research, Vol 135, 2021, PP 270-278. DOI: 10.1016/j.jpsychires.2021.01.022.

• More than half of patients with PANS require psychotropic medication.
• Side effects requiring a therapy change are common.
• Drug doses at which side effects occur are usually less than recommended.
• Clinicians should start with lower doses of psychotropics in PANS patients.

“Antidepressants’ most common side effects were anxiety, agitation, aggression, and akathisia. Antipsychotics’ most common side effects were dystonia, aggression, self-injurious behavior, and movement abnormality. Side effects were common at doses lower than the suggested starting doses for these medications. Patients tolerated antidepressants and antipsychotics when doses were low.”

Thienemann Margo, Murphy Tanya, Leckman James, Shaw Richard, Williams Kyle, Kapphahn Cynthia, Frankovich Jennifer, Geller Daniel, Bernstein Gail, Chang Kiki, Elia Josephine, and Swedo Susan
Journal of Child and Adolescent Psychopharmacology-July 2017
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While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child’s presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.