Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
medsphere.wordpress.com/2020/12/11/pandas/
medsphere.wordpress.comPosted Dec 12, 2020, 3:46 PM UTC
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medsphere.wordpress.comIt's definitely a valid, helpful diagnostic category. We've had quite a few obvious cases come through our clinic. I don't think Sydenham's Chorea was controversial.
The issue now is, like with Lyme Disease and many others before it, most of the people I see claiming/looking for this diagnosis do not warrant this diagnosis.
I think the more controversial topic is how to treat it.
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Americans and their acronyms
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I haven’t personally come to a strong stance on the legitimacy of PANDAS.
On one hand, there are some studies showing a correlation at least. I remind myself that there is so much to psych/neuro we just don’t fully understand yet. On the other hand, my experience with PANDAS has been patients spending incredible amounts of money at PANDAS-centered clinic in which parents seek out treatment for (what to me) appears to be standard OCD or other mental illness; I have not seen (anecdotally) and change in function after these treatment programs except for a lighter wallet. But my sample size is low and C&A psych is not my specialty, so I very well may be wrong.
If anyone can provide me some quality literature I may have missed, I am open to learning more.
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Very interesting discussion in the neurology sub about the validity of the PANDAS diagnosis. I know the Dx is already somewhat controversial but based on that thread it seems pediatricians are more accepting of the Dx while neurologists are skeptical.
What do psychiatrist around the globe think of this entity? Is it a north american thing? In your region do psychiatrists have a role in the management? Does the pathophysiology convinces you?
I’ve seen enough PANS and PANDAS to be convinced although there is a specific clinic just for that in the institution I work at. It may have been first described in the USA but many of the reviews and studies now have been conducted abroad, including PANDAS/PANS clinics such as the Karolinska Insitute in Sweden.
Our psychiatrists mainly handle these patients given the rapidity of psychiatric symptoms. We have our neuroimmunology colleagues involved as well but they tend to treat the autoimmune encephalitis and pediatric-onset MS cases more.
The pathophysiology in psychiatry always lags behind the behavioral descriptive syndromic diagnoses. Whether or not I understand the underlying diagnoses doesn’t mean patients can’t benefit from treatment.
Well, I've seen it so I tend to believe its legit. I didn't directly care for this child so I don't have all the details but it was a 15 year old adolescent, no previous psych history, got strep throat and then about a month later become floridly psychotic. Didn't respond to antipsychotics, was given an antibiotic (don't recall which) and symptoms remitted.
Given the highly suggestible nature of many psychosomatic patients, and the stigma against psychotropics and in favor of antibiotics and other "real" medicines, it's hard to rule out a placebo based on this description though of course you witnessed the case and I did not.
Absolutely - n=1, and like I said I didn't manage the case so I'm not sure where the thinking was and all the other details. But, it was fascinating in any case.
Yes, yes! A thousand times yes!!!!
The patient would need to experience the same thing again. People can become psychotic spontaneously then get better spontaneously, so you don't know that it was related to the strep throat at all.
This is the main neurology sub?
My bad.
The post in the neurology sub was a crosspost from the human diseases sub so when I crossposted the neurology post it crossposted the original post.