Lecture Notes: PANDAS - Questions and Answers

Overview

What is PANDAS?

• PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
• Diagnosed when:
  • OCD, tic disorder, or both appear suddenly after a strep infection.
  • Symptoms worsen post-strep infection.
• Symptoms can include:
  • Motor/vocal tics, obsessions, compulsions.
  • Moodiness, irritability, anxiety, separation concerns.

Causes of PANDAS

• Strep Bacteria: Uses molecular mimicry to hide from the immune system.
• Antibodies produced react to both strep and mimicked human molecules.
• Cross-reactive antibodies can target the brain, leading to OCD, tics.

Adult PANDAS

• Considered a pediatric disorder, typically appears age 3 to puberty.
• Rare occurrences in adolescents; not fully studied in adults.

Signs and Symptoms

Diagnosis of PANDAS

• Clinical diagnosis without lab tests.
• Diagnostic criteria includes:
  • OCD or tic disorder.
  • Onset between age 3 to puberty.
  • Episodic symptom severity.
  • Associated with strep infection.
  • Neurological abnormalities.

Associated Symptoms

• ADHD symptoms, separation anxiety, mood changes.
• Sleep disturbances, bed-wetting, changes in motor skills.

Episodic Course of Symptoms

• Sudden onset or worsening, gradual improvement.
• Symptoms worsen with new strep infections.

Strep Titer Information

• Elevated titers indicate past infection, not active.
• Labs vary in normal titer range.

Approaching Doctors Unfamiliar with PANDAS

• Contact International OCD Foundation or PANDAS Physicians Network.

Treatment

Antibiotics

• Treat acute PANDAS by addressing strep infection.
• Culture and antibiotics to eradicate strep.

Managing Neuropsychiatric Symptoms

• Medications, cognitive behavioral therapy (CBT), SSRI.
• Start with low dosages, adjust gradually.

Plasma Exchange or IVIG

• For severely affected children.
• Improves symptoms but has side effects and risk of infection.

Other Considerations

• Elevated titers shouldn't be treated with antibiotics.
• Penicillin doesn't treat PANDAS symptoms.
• Tonsillectomy not proven helpful.

Participating in Clinical Research

• Clinical trials explore new treatments.
• Discuss with doctors about benefits and risks.

Finding Help

Behavioral Health Treatment Services Locator

• Online resource by SAMHSA for locating mental health facilities.

Questions for Doctors

• Importance of communication for better healthcare outcomes.

Reprints and More Information

• Publications in the public domain.
• Contacts for more resources and information:
  • NIMH website
  • MedlinePlus
  • ClinicalTrials.gov

Contact Information:

• NIMH, Office of Science Policy, Planning, and Communications
• Phone: 301-443-4513, Toll-free: 866-615-6464
• Email: [email protected]

Publication: NIH Publication No. 19-MH-8092, Revised 2019