Pediatric acute-onset neuropsychiatric syndrome (PANS) is a phenomenon characterized by a child exhibiting an abrupt and dramatic onset of OCD symptoms that is accompanied by a the presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least 2 of the following 7 categories:
(a) anxiety (b) emotional liability and/or depression (c) irritability, aggression, and/or severely oppositional behaviors (d) behavioral (developmental) regression (e) sudden deterioration in school performance (f) sensory or motor abnormalities (g) somatic/physical signs and symptoms, including sleep disturbances, enuresis or urinary frequency.
Additionally, symptoms are not better explained by a known neurologic or medical disorder.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) A possible association has also been shown in which patients develop OCD after experiencing a group A b -hemolytic streptococcal infection. This subgroup of pediatric patients with OCD or tic disorders has been classified as pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). In PANDAS, children show a rapid onset of significant behavioral changes and OCD symptoms temporally associated with a strep infection.
All five criteria must be met for PANDAS: 1) Presence of obsessive-compulsive disorder (OCD) or a tic disorder 2) Prepubertal symptom onset 3) Acute symptom onset and episodic (relapsing-remitting) course 4) Temporal association between Group A streptococcal infection and symptom onset/exacerbations 5) Associated with neurological abnormalities, (particularly motoric hyperactivity and choreiform movements)
Preliminary research indicates that cognitive-behavioral therapy (CBT) may be an appropriate treatment option for youth with PANDAS-related OCD (Storch et al., 2006).
The immunobiology of Tourette’s disorder, pediatric autoimmune neuropsychiatric disorders associated with Streptococcus, and related disorders: A way forward. Special Issue on Obsessive-Compulsive Disorder and Tourette’s Disorder: Murphy, T. K., Kurlan, R., & Leckman, J. (2010). Journal of Child and Adolescent Psychopharmacology, 20, 317–331. doi: 10.1089/cap.2010.0043.
A pilot trial of cognitive-behavioral therapy augmentation of antibiotic treatment in youth with pediatric acute-onset neuropsychiatric syndrome-related obsessive-compulsive disorder. Nadeau, J.M.; Jordan, C., Selles, R.R., Wu, M.S., King, M.A.., Patel, P.D. (2015).Journal of Child and Adolescent Psychopharmacology, 25, 337-343.
Behavioral Treatment of a Child with PANDAS. Storch, E.A.., Gerdes, A.C., Adkins, J.W., Geffken, G.R., Star, J., Murphy, T. (2004). Journal of the American Academy of Child & Adolescent Psychiatry, 43, 510-511.
Cognitive-behavioral therapy for PANDAS-related obsessive-compulsive disorder: Findings from a preliminary waitlist controlled open trial. Storch, E. A., Murphy, T. K., Geffken, G. R., Mann, G., Adkins, J., Merlo,L.J., Duke, D., Munson, M., Swaine, Z., & Goodman, W. K. (2006). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1171–1178. doi:10.1097/01.chi.0000231973.43966.a0
From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Swedo, S. E., Leckman, J. F., & Rose, N. R. (2012). Pediatrics and Therapeutics, 2, 1–8. doi:10.4172/2161-0665.1000113 Link to Article
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