Comparison of Clinical Characteristics of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Childhood Obsessive-Compulsive Disorder

Abstract

Objective: The objectives of this study were to identify unique clinical characteristics of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) compared with a control group of children with non-PANDAS obsessive-compulsive disorder (OCD) with respect to ancillary symptoms, types of obsessions and compulsions, symptom severity, and co-morbid DSM-IV diagnoses. Method: Classification of PANDAS was based on review of pediatric and psychiatric records using the criteria developed by Swedo and colleagues. Children aged 6-14 with PANDAS (n ¼ 21) and non-PANDAS OCD (n ¼ 18) were assessed by blind independent evaluators using the PANDAS Questionnaire, Children's Yale-Brown Obsessive Compulsive Scale, Yale Global Tic Severity Scale, and Anxiety Disorders Interview Schedule for DSM-IV. Results: PANDAS children were significantly more likely to present with separation anxiety, urinary urgency, hyperactivity, impulsivity, deterioration in handwriting, and decline in school performance during their initial episode of neuropsychiatric illness compared with children with OCD. Total tics and vocal tics were more severe in PANDAS children. Separation anxiety disorder and social phobia were more prevalent in non-PANDAS OCD children. Children with non-PANDAS OCD were significantly more likely to include others in their rituals. There were no significant differences between groups on demographics or severity of OCD. Conclusions: Distinguishing clinical characteristics in PANDAS, which included urinary urgency, hyperactivity, impulsivity, and deterioration in handwriting, are linked to basal ganglia functions. These clinical characteristics will aid in the differentiation of PANDAS children for research and clinical purposes and ultimately advance our understanding and treatment of this disorder.

Streptokok Enfeksiyonu İle İlişkili Pediatrik Otoimmün Nöropsikiyatrik Hastalıklar: Kulak Burun Boğaz Hekiminin Yeri

“…Bunların sıklıkla bir arada görüldüğü bilinmektedir. Yapılan araştırmalarda PANDAS hastalarında en sık rastlanan obsesyonlar; kontaminasyon, kendine veya başkasına zarar verme, simetri, cinsel ve dini düşünceler şeklinde iken, en sık görülen kompulsiyonlar; el yıkama, kontrol etme, dokunma, sayı sayma, tekrar etme şeklindedir 21 . Tik bozuklukları, tekrarlayıcı, ani ve amaçsız hareketler ya da sesler olarak tarif edilmektedir.…”

“…Tikler basit tek hareket veya ses şeklinde görülebilirken, kompleks ve amaçlı gibi görünen hareketler şeklinde de görülebilir. Bunlar içinde en sık; göz kırpma, omuz silkme, yüz kırıştırma, dokunma, boğaz temizleme ve burun çekme görülür 21 .…”

“…Akut alevlenmeler sırasında görülen diğer psikiyatrik semptomlar arasında; yeni başlayan idrar kaçırma, ayrılma anksiyetesi, hiperaktivite, kişilik değişiklikleri, irritabilite, el yazısının kötüleşmesi ve matematik becerilerinin gerilemesi sayılabilir 21 . PANDAS hastalarındaki bu klinik bulguların AGBHS enfeksiyon ile ilişkili olarak akut alevlenmeler şeklinde görüldüğü bildirilmektedir.…”

Optimal management of pediatric obsessive-compulsive disorder

“…These youths also exhibit additional neuropsychiatric symptoms (eg, anxiety, emotional lability and/or depression, irritability, aggression and/or severely oppositional behaviors, developmental regression, rigid or repetitive behaviors, tics, worsening fine motor skills, and compulsive urination) and show a marked deterioration in school performance and adaptive functioning. 22,23 Furthermore, symptom onset in a subgroup of these children is associated with an infectious trigger. Youth with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) have prepubertal, acute onset of episodic (relapse-remitting) obsessivecompulsive symptoms or tics that have a temporal association with Group A streptococcal infections.…”

“…25 They also display neurologic abnormalities such as motor hyperactivity and choreiform movements. [22][23][24][25] In comparison, youth who display obsessive-compulsive symptoms or tics after any infection, not limited to Group A streptococcal infections, are broadly characterized as having PITANDS (Pediatric Infection-triggered Autoimmune Neuropsychiatric Disorders) with sudden, recurrent, prepubertal clinically significant obsessive-compulsive and/or tic symptoms that are triggered or exacerbated by a bacterial or viral infection (eg, influenza, varicella, Group A streptococcus). 25 Although evidence for the neuropsychiatric syndromes based on infections is not without controversy, and submit your manuscript | www.dovepress.com definitive data do not exist at this time regarding treatment for PANS, clinicians should treat infections in the child as dictated by pediatric practice guidelines.…”