Dramatic Mood Swings, Extreme Anxiety Sigs of OCD

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Scientists at the National Institutes of Health are studying an aspect of obsessive compulsive disorder (OCD) they say is separate from a form of OCD often initiated by a strep infection. They are calling the new disorder Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) which can suddenly strike children or teens.

In the past, studies of OCD in children tended to dwell upon Pediatric Autoimmune Neuropsychiatric Disorder Association with Streptococcus (PANDAS) which is limited to a subset of cases traceable to an autoimmune process triggered by a strep infection. However, in a news release this week from the National Institute of Mental Health, Dr. Susan Swedo said her studies look at children and teens who suddenly develop an on-again/off-again OCD symptoms or abnormal eating behaviors along with psychiatric symptoms with any known cause.

“Parents will describe children with PANS as overcome by a ferocious onset of obsessive thoughts, compulsive rituals and overwhelming fears.” Swedo was one of the first researchers to characterize PANDAS two decades ago.
“Clinicians should consider PANS when children or adolescents present with such acute-onset OCD or eating restrictions in the absence of a clear link to strep.”

The criteria evolved from a PANDAS workshop at the National Institutes of Health in July 2010 orchestrated by Swedo. A broad group of scientists, clinical people, and OCD advocates participated in the workshop which included evaluations of 400 youth diagnosed with PANDAS. The research confirmed that boys outnumbered girls by more than 2:1 with psychiatric symptoms, usually beginning before eight years of age.

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Because PANS doesn’t seem to have a specific cause unlike PANDAS, scientists are treating each instance of the disorder on a case by case basis. “PANS will likely turn out to include a number of related disorders with different causes that share a common presentation,” Swedo said.

Emerging from the workshop in 2010 and in studies conducted since, are three criteria patients must meet to be generally accepted as cases of PANS:

1. Abrupt, dramatic onset of OCD or anorexia.
2. Concurrent presence of at least two additional neuropsychiatric symptoms with similarly severe and acute onset. These include: anxiety; mood swings and depression; aggression, irritability and oppositional behaviors; developmental regression; sudden deterioration in school performance or learning abilities; sensory and motor abnormalities; and somatic signs and symptoms.
3. Symptoms are unexplainable by a known neurologic or medical disorder.

Additionally, Swedo said that among the wide range of accompanying symptoms, children may appear terror stricken or suffer extreme separation anxiety, shift from laughter to tears for no apparent reason or regress to temper tantrums, baby talk or bedwetting. In some cases, she said, their handwriting and other fine motor skills worsen dramatically.

Contact: Jules Asher
[email protected]

Reference:
Swedo, SE, Leckman JF, Rose, NR. From Research Subgroup to Clinical Syndrome: Modifying the PANDAS criteria to describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Feb 2012, Pediatrics & Therapeutics.

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