Fern Jaspers-Fayer1,2, Sang Hun Jerry Han3, Elaine Chan1, Katherine McKenney4, Annie Simpson4, Andrea Boyle4, Rhonda Ellwyn1, S Evelyn Stewart1,2,5,6,7. 1. 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada . 2. 2 Department of Psychiatry, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada . 3. 3 School of Medicine, Wayne State University , Detroit, Michigan. 4. 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada . 5. 5 Massachusetts General Hospital , Boston, Massachusetts. 6. 6 Harvard Medical School , Boston, Massachusetts. 7. 7 Department of Psychiatry, BC Children's Hospital , Vancouver, British Columbia, Canada .
Abstract
BACKGROUND: Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood. OBJECTIVES: To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview. METHODS: Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups. RESULTS: Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode. CONCLUSION: A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.
BACKGROUND:Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood. OBJECTIVES: To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview. METHODS: Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups. RESULTS: Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode. CONCLUSION: A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.
Authors: Clara Westwell-Roper; Kyle A Williams; Jack Samuels; O Joseph Bienvenu; Bernadette Cullen; Fernando S Goes; Marco A Grados; Daniel Geller; Benjamin D Greenberg; James A Knowles; Janice Krasnow; Nicole C McLaughlin; Paul Nestadt; Yin-Yao Shugart; Gerald Nestadt; S Evelyn Stewart Journal: J Child Adolesc Psychopharmacol Date: 2019-06-06 Impact factor: 2.576
Authors: Jacek Baj; Elżbieta Sitarz; Alicja Forma; Katarzyna Wróblewska; Hanna Karakuła-Juchnowicz Journal: Int J Mol Sci Date: 2020-02-21 Impact factor: 5.923