If you have a patient presenting with repetitive behaviors and chronic anxiety, it may be obsessive compulsive disorder (OCD) or it may be PANDAS/PANS.
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is the sudden, rapid-onset of obsessive compulsive behavior, as well as possible movement and behavioral abnormalities, following a Streptococcus pyogenes (Group A Strep) infection. The condition is hypothesized to be the result of autoimmune antibodies mistakenly attacking an area of the brain, the basal ganglia, rather than the intended infectious agent.
Recent research has shown that Streptococcus pyogenes is not the only infectious agent that can cause these sudden-onset symptoms. In a condition known as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), similar symptoms are observed due instead to other infectious agents such as mycoplasma, mononucleosis, Lyme disease, and the H1N1 flu virus.
In contrast to the gradual onset of symptoms in pediatric OCD, symptoms for patients with PANDAS/PANS may develop over the course of a few days and may quickly become severe.
There are several recognizable differences between OCD and PANDAS/PANS:
Pediatric OCD |
PANDAS/PANS |
||
Age |
Typically see first onset between 8–12 years old. | Typically affects children between 4–14 years old. | |
Timeline |
Subclinical symptoms become gradually more severe over time. | Acute, dramatic onset of symptoms. | |
Symptoms |
Experience a wide range of symptoms, cycling between obsessions that cause anxiety and compulsions to reduce it. Common obsessions may include fears of contamination, pathological doubt, unwanted thoughts and/or images of an aggressive, religious, or sexual nature, or the need for symmetry. Common compulsions may involve excessive checking, washing and/or cleaning, or reassurance seeking, counting, ordering, or arranging things. | Sudden, rapid-onset of obsessive-compulsive behavior, as well as possible movement and behavioral abnormalities, including:
|
|
Cause |
There is a probable familial/genetic link and possible involvement of the cortico-striato-pallidothalamic (CSPT) pathway. Chronic avoidance of anxiety-producing stimuli is also seen as a contributing factor. | PANDAS: Hypothesized to be the result of autoimmune antibodies mistakenly attacking the basal ganglia in the brain following a Streptococcus pyogenes (Group A Strep) infection. | PANS: Hypothesized to be the result of autoimmune antibodies mistakenly attacking the basal ganglia in the brain following an infection such as mycoplasma, mononucleosis, Lyme, or H1N1. |
Download this table as print-friendly PDF.
Acute-onset OCD (PANDAS/PANS) is not the typical presentation of pediatric OCD. If you have a patient presenting with the symptoms listed above with a sudden onset: Test, Treat, and Team Up.
Test for active infections, especially strep, within 3 weeks of onset. If clinically indicated, additionally test for mycoplasma, mononucleosis, Lyme disease, or H1N1.
Treat any active infections thoroughly.
- Use antibiotics to treat active infections according to the standards of care for each infectious agent.
- Intravenous Immunoglobulin (IVIG) may be recommended for severe or persistent cases.
Team Up with a pediatric OCD specialist to help create a treatment plan. A licensed mental health professional will use a form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) to treat the OCD symptoms.