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PANDAS and PANS: Relationship to OCD

Can strep or another infection cause some children or adolescents to develop symptoms of Obsessive-Compulsive Disorder (OCD)?

Drs. Susan Swedo, Henrietta Leonard, and Judith Rapoport of The National Institute of Mental Health considered this question. They examined cases when OCD, often accompanied by tics, had an unusually rapid onset following a strep infection, or similar medical problem. The terms PANDAS, and later PANS, were coined to describe such cases. PANDAS is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, PANS means Pediatric Acute-onset Neuropsychiatric Syndrome.

This group of patients often had also developed, seemingly “overnight,” dramatic changes in their behaviors, emotional expression, and habits, even in their academic abilities.

Yet, understanding these cases and how to treat them remains very complicated—even experts often disagree about how best to proceed. Before considering diagnosing PANDAS/PANS, it is important to rule out other medical conditions that could create similar clinical presentations. However, it is common to use laboratory tests, like having blood drawn, to see if strep or another sort of infection is, or has been, present.

Alongside any medical treatments that might be utilized (e.g. antibiotics, infusions, OCD medications) it appears that Cognitive Behavioral Therapy (CBT) protocols that are employed for OCD in general are also indicated for this population, including Exposure and Response prevention (ERP). CBT can also be utilized to address the tics and other problems that may exist. Given the sudden and unexpected onset of symptoms, addressing the questions and concerns of parents and other family members is paramount. Implementing CBT as soon and consistently as possible after symptoms develop should also be strongly considered.

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