If you have a patient presenting with repetitive behaviors and chronic anxiety, it may be obsessive compulsive disorder (OCD) or it may be a subtype of OCD: Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)/Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). There are recognizable differences between these conditions:
Pediatric OCD |
PANDAS/PANS |
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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:
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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. |
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