PANDAS

PANDAS, which stands for Pediatric Auto-Immune Disorder Associated with Streptococcus, is a little-known illness which most pediatricians or child psychotherapists know little or nothing about. This neuropsychiatric disorder is typically marked by the sudden onset of facial or motor tics and obsessive-compulsive disorder, seemingly occurring overnight. Other features that are sometimes associated with it are irritability and ups and downs in mood, separation anxiety, handwriting deterioration, loss of math skills, new sensitivity to clothing,, or touch, poor attention span, separation anxiety, new bedtime fears, mood lability..For an estimated 25-30% of children with obsessive-compulsive disorder (OCD), the episode is thought to be triggered or exacerbated by the body’s own immune cells which, raher than attacking the strep, attack the brain’s basal ganglia instead. There is a form of Anorexia Nervosa that is associated with a strep infection.

Susan Swedo, MD and colleagues (Swedo, Leonard et al 1998) were the first to describe a post-infectious etiology for OCD and to define criteria identifying the PANDAS subgroup studied (N=50). Swedo and others are studying PANDAS at the Pediatrics & Developmental Neuropsychiatry Branch of the National Institute of Mental Health (NIMH,) where the focus is on diagnosis and treatment of childhood neuropsychiatric conditions (Sydenham’s chorea, Tourette Syndrome, OCD, and autism spectrum disorders.

As with any newly identified syndrome, the PANDAS diagnosis is controversial. Its usefulness is disputed by some scientists who think this sub-set of patients does not differ significantly from the remainder of the patient population, and that infections do not increase the risk of OCD or tics. PANDAS is currently not listed as a diagnosis by the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The diagnosis of PANDAS is a clinical diagnosis; there are no lab tests that can diagnose PANDAS. The clinical features of the illness are the only means of determining whether or not a child might have PANDAS. Both a throat culture and a blood test that looks for streptococcus antibodies (Serology for ASOT and AntiDNAseB) can identify a recent strep infection.

In addition to treatment with antibiotics, treatments for children with PANDAS is the same as if they had other types of OCD or tic disorders. Whether their OCD is strep. triggered or not, children with OCD benefit from cognitive-behavioral therapy and at times, the SSRI medications. Some experts also recommend nutritional supplements.

There has been some research into anorexia nervosa triggered by a strep infection, with considerable improvements occurring after beginning treatment with antibiotics.

The PANDAS model is a complex and rapidly-moving area of medical research.

I have some experience in the psychotherapy of children with PANDAS, and am knowledgeable about other treatment resources.