Pediatric Obsessive–Compulsive Disorder (OCD) & Tics

PANS is a neuropsychiatric illness in children in which there is the sudden onset of OCD and/or tics, which has been identified by researchers at the Pediatrics & Developmental Neuropsychiatry Branch of the National Institute of Mental Health (NIMH). It is more commonly known by its former acronym, PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection, because the first known cases were in children who had strep throat and then suddenly developed obsessive –compulsive disorder (OCD) and/or tics. Now it is known that other infections such as mycoplasma, certain viruses, and Lyme disease can also produce the same symptoms, so the current name is PANS. As with any newly identified syndrome, the diagnosis is controversial. Neither PANDAS nor PANS is currently listed as a diagnosis by the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Most people may not have heard of PANDAS or PANS. I will tell you about PANDAS, because that is the illness about which I am most familiar with clinically. Some researchers say it does not exist. Others are certain that it does, but is rare. Some claim it is even more prevalent than autism but goes undiagnosed and untreated in most children who have it. Some pediatricians are immediately dismissive of the possibility that the child’s symptoms suggest a possible PANDAS diagnosis. Those who do not dismiss the possibility of PANDAS often do not know what kind of strep to test for, and most labs cannot detect it properly, so it is essential that the physician making the diagnosis be very knowledgeable about the illness. Unfortunately, few physicians are.

The PANDAS diagnosis is used to describe a set of children who have, typically, rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorders such as Tourette Syndrome (TS). Tourette’s is characterized by motor how to stop ocd tics and at least one vocal tic, which wax and wane, such as blinking, coughing, throat clearing, sniffing, facial movements, jumping, swatting, uttering obscenities. Sometimes the OCD may center around eating. An isolated tic is generally not Tourettes, and is usually caused by stress. PANDAS begins typically several months following a group A beta-hemolytic streptococcal (GABHS) infection such as strep throat or scarlet fever.