Differential Diagnosis of OCD or PANDAS/PANS

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

 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:

  • Severe separation anxiety
  • Anorexia or disordered eating
  • Urinary frequency
  • Tics and/or purposeless motor movements
  • Acute handwriting difficulty
 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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Click here to learn about how to treat Pediatric OCD and/or PANDAS/PANS.