PANDAS and anorexia nervosa—a spotters' guide: Suggestions for medical assessment

Abstract

When PANDAS-Anorexia Nervosa (PANDAS-AN) is suspected clinically we recommend conducting all the above investigations. The more positive results there are the more likely is the diagnosis, but particular weighting should be given to AnAb and D8/17.

From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)

“…In some patients, body image distortions appeared to drive the weight-loss inducing behaviors; while in the majority, the body image distortions appeared only after the child had lost a significant amount of weight (10-15% of starting weight) as a result of food intake restrictions that were related to obsessional preoccupations with the texture of food and a fear of choking, vomiting or contamination from ingesting specific foods [6,7,[45][46]. Subsequent reports have confirmed the significant symptom overlap between eating restrictions and OCD [47,48]. Thus, the working PANS criteria specify that the sudden onset of eating restrictions or anorexic behaviors can fulfill the first criterion, even in the absence of more typical symptoms of OCD.…”

Eating Disorders, Autoimmune, and Autoinflammatory Disease

“…15,16 Acute anorexia nervosa (AN) onset after a streptococcal infection and/or an autoimmune reaction (eg, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection leading to onset AN) has been documented, yielding recommendations for examining measures of antineuronal antibodies, such as AnAb and D8/17, to assess suspected pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection leading to AN onset. 17,18 Population studies in Finland and the United Kingdom 19,20 associated antecedent autoimmune diseases with a significantly increased risk for eating disorders, and data from a nationwide Swedish study revealed a bidirectional association between celiac disease and AN. 21 In our previous work, 22 we revealed that adults with AN, perhaps because of low adipose tissue and high physical activity, have a distinct pattern of immune mediator expression (ie, low cytokines, elevated high-mobility group box 1 protein) that differs from other somatic and psychiatric illnesses.…”

Implications for Advanced Practice Nurses When Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS) Is Suspected: A Qualitative Study

“…Used for prophylaxis of streptococcal infections; if the patient is able to swallow, oral routes are sufficient; may also consider treating family members prophylactically Nonsteroidal anti-inflammatory drugs Risk for bleeding and gastric ulcers Cognitive behavioral therapy Used to address anxiety and mood disorders antibodies, and antistreptolysin can be useful in determining if the child had a streptococcal infection but are not definitive for a PANDAS diagnosis (Vincenzi et al, 2010). Some authors have described very specific diagnostic criteria for PANDAS but argued that Lyme disease, OCD, Tourette's syndrome, and tic disorders can also present with similar diagnostic criteria, including streptococcal infections, thus leading to misdiagnosis (Mell, Davis, & Owens, 2005;Rhee & Cameron, 2012).…”

“…serum biological marker to aid in the diagnosis has been identified (Vincenzi, O'Toole, & Lask, 2010). The presence of autoantibodies in children with suspected PANDAS is contested as a definitive diagnostic tool (Singer, Hong, Yoon & Williams, 2005).…”