scholarly journals No Neurochemical Evidence of Neuronal Injury or Glial Activation in Children with Paediatric Acute-onset Neuropsychiatric Syndrome

2020 ◽  
Author(s):  
Mats Johnson ◽  
Elisabeth Fernell ◽  
Christopher Gillberg ◽  
Anders Fasth ◽  
Kaj Blennow ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Neuropsychiatric Symptoms ◽  
Neuronal Injury ◽  
Acute Onset ◽  
University Hospital ◽  
Serum Concentrations ◽  
Obsessive Compulsive ◽  
Neurofilament Light ◽  
Compulsive Disorder ◽  
Autoimmune Aetiology

Abstract Background Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by an acute onset of obsessive compulsive disorder, combined with at least two other neuropsychiatric symptoms with similarly acute onset. Diagnostic criteria also require that no specific medical aetiology is identified. Although there are no verified aetiological biomarkers, PANS is assumed to be a neuroinflammatory disorder with a possible autoimmune aetiology. Neurochemical markers such as neurofilament light (NfL, a neuronal injury marker) and glial fibrillary acidic protein (GFAP, an astrocytic activation marker) have not been published for this patient group.Methods Blood samples from 17 children meeting diagnostic criteria for PANS, after assessment at the Child Neuropsychiatry Centre, Sahlgrenska University Hospital, Gothenburg, Sweden, were analysed for serum concentrations of NfL and GFAP. Ten age-matched children without any neurological or psychiatric disorder served as a comparison group. Results No difference was found in mean NfL and mean GFAP serum concentrations between children with PANS and controls. NfL and GFAP concentrations did not correlate with disease duration between PANS onset and time of blood tests. Conclusion Neuronal injury and astrocyte activation do not seem to be a major event in PANS. The study group was small, and even if findings may be reassuring for parents and patients, they should be interpreted with caution and verified in larger cohort and possibly with other markers in both serum and CSF.

scholarly journals Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

2021 ◽  
Vol 9 ◽  
Author(s):  
Adriana Prato ◽  
Mariangela Gulisano ◽  
Miriam Scerbo ◽  
Rita Barone ◽  
Carmelo M. Vicario ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Diagnostic Procedures ◽  
Neuropsychiatric Disorders ◽  
Sudden Onset ◽  
Acute Onset ◽  
Streptococcal Infections ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Appropriate Treatment ◽  
Clinical Conditions

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

scholarly journals Pediatric Acute-onset Neuropsychiatric Syndrome and Mycoplasma Pneumoniae Infection: A Case Report Analysis with a Metabolomics Approach

2020 ◽  
Vol 16 (3) ◽  
pp. 183-193 ◽  
Author(s):  
Cristina Piras ◽  
Roberta Pintus ◽  
Dario Pruna ◽  
Angelica Dessì ◽  
Luigi Atzori ◽  
...  
Keyword(s):  
Case Report ◽  
Protein Biosynthesis ◽  
Neuropsychiatric Symptoms ◽  
Acute Onset ◽  
Point Of View ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Before And After ◽  
New Biomarkers ◽  
The Individual

: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical condition characterized by a sudden and dramatic obsessive-compulsive disorder with a suggested post-infectious immune-mediated etiology. This condition is accompanied by an extensive series of relatively serious neuropsychiatric symptoms. The diagnosis of PANS is made by "exclusion", as the individual PANS symptoms overlap with a multiplicity of psychiatric disorders with the onset in childhood. A number of researchers accumulated evidence to support the hypothesis that PANS was closely associated with a number of infections. : In the last decade, metabolomics played an essential role in improving the knowledge of complex biological systems and identifying potential new biomarkers as indicators of pathological progressions or pharmacologic responses to therapy. The metabolome is considered the most predictive phenotype, capable of recognizing epigenetic differences, reflecting more closely the clinical reality at any given moment and thus providing extremely dynamic data. In the present work, the most recent hypothesis and suggested mechanisms of this condition are reviewed and the case of a 10 - year-old girl with PANS is described, before and after clarithromycin treatment. The main results of this case report are discussed from a metabolomics point of view. The alteration of several metabolic pathways concerning the microbial activity highlights the possible role of the microbiome in the development of PANS. Furthermore, different metabolic perturbations at the level of protein biosynthesis, energy and amino acid metabolisms are observed and discussed. Based on our observations, it is believed that metabolomics is a promising technology to unravel the mysteries of PANS in the near future.

scholarly journals Schizophrenia-spectrum psychopathology in obsessive–compulsive disorder: an empirical study

2019 ◽  
Vol 270 (8) ◽  
pp. 993-1002 ◽  
Author(s):  
Andreas Rosén Rasmussen ◽  
Julie Nordgaard ◽  
Josef Parnas
Keyword(s):  
Diagnostic Criteria ◽  
Obsessive Compulsive Disorder ◽  
Psychotic Symptoms ◽  
Main Diagnosis ◽  
Schizophrenia Spectrum Disorders ◽  
Obsessive Compulsive ◽  
Main Research ◽  
Compulsive Disorder ◽  
Diagnostic Potential ◽  
Schizophrenia Spectrum

Abstract The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession (‘with resistance’) and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive–compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.

scholarly journals An Atypical Presentation of Pediatric Acute Neuropsychiatric Syndrome Responding to Plasmapheresis Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Drew H. Barzman ◽  
Hannah Jackson ◽  
Umesh Singh ◽  
Marcus Griffey ◽  
Michael Sorter ◽  
...  
Keyword(s):  
Treatment Options ◽  
Abrupt Onset ◽  
Acute Onset ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Acute Infections ◽  
The Family ◽  
Work Up ◽  
Severe Anxiety ◽  
Very High

Here we report a case of a 15-year-old female who had originally been diagnosed and treated unsuccessfully for schizophrenia, psychosis, severe anxiety, and depression. More in-depth history revealed an abrupt onset of her symptoms with remote acute infections and many exhibited characteristics of obsessive compulsive disorder with rituals. Work-up for underlying infectious, immunodeficiency, and autoimmune causes was unrevealing except for very high levels of anti-neuronal antibodies which have been linked to Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Treatment options were discussed with the family and it was decided to use a course of plasmapheresis based on previous studies demonstrating efficacy and its safety profile. After course of therapy, there was a dramatic resolution of her psychosis, OCD traits, and anxiety. She was able to stop all of her antipsychotic and anxiety medications and resume many of her previous normal daily activities. The effect of this treatment has been sustained to the present time. This case emphasizes the importance of exploring nontraditional treatments for severe, treatment-resistant mental illness which requires a multidisciplinary approach. Further research is warranted in larger populations to investigate pathomechanisms and treatment of PANs/PANDAs.

Dual Target Repetitive Transcranial Magnetic Stimulation In The Treatment Of Comorbid Obsessive-Compulsive Disorder In Patients With Anorexia Nervosa: Preliminary Results Of Two Case Reports

2016 ◽  
Vol 33 (S1) ◽  
pp. S494-S494
Author(s):  
N. De Schryver ◽  
G.M.D. Lemmens ◽  
C. Baeken ◽  
D. Van den Abbeele
Keyword(s):  
Anorexia Nervosa ◽  
Transcranial Magnetic Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
University Hospital ◽  
Hospital Treatment ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

IntroductionObsessive-compulsive disorder (OCD) is a frequently reported comorbid disorder (20–30%) in patients with anorexia nervosa (AN). Increasing evidence suggests that repetitive transcranial magnetic stimulation (r-TMS) may be effective in the treatment of refractory OCD and to a lesser extent in AN. Hereby, different target areas: supplemental motor area (SMA) and orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex in AN. We report two patients with enduring AN and comorbid treatment resistant OCD treated with r-TMS.MethodsBoth female patients (34 and 26 years respectively) were hospitalized at the Eating Disorder Unit at the Ghent University Hospital. Treatment responses were evaluated with Yale Brown Obsessive Compulsive Scale (Y-BOCS) and weight gain. Inhibitory continuous thetaburst stimulation (cTBS) of the SMA followed by cTBS of the OFC was conducted during 20 sessions, 5 sessions a week, during 4 weeks. Stimulation intensity was respectively 100% and 80% of the motor treshold.ResultsAfter cTBS treatment Y-BOCS score of both patients decreased (31 to 24 and 31 to 23 respectively). Only one patient showed a 10% increase of weight. The treatment was well tolerated. No significant side effects were reported.ConclusionTreatment resistant comorbid OCD in patients with AN may be succesfully treated with cTBS.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Immunological causes of obsessive-compulsive disorder: is it time for the concept of an “autoimmune OCD” subtype?

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Dominique Endres ◽  
Thomas A. Pollak ◽  
Karl Bechter ◽  
Dominik Denzel ◽  
Karoline Pitsch ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Autoimmune Diseases ◽  
Obsessive Compulsive Disorder ◽  
Autoimmune Encephalitis ◽  
Acute Onset ◽  
Brain Diseases ◽  
Recent Experience ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Red Flag

AbstractObsessive-compulsive disorder (OCD) is a highly disabling mental illness that can be divided into frequent primary and rarer organic secondary forms. Its association with secondary autoimmune triggers was introduced through the discovery of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute onset Neuropsychiatric Syndrome (PANS). Autoimmune encephalitis and systemic autoimmune diseases or other autoimmune brain diseases, such as multiple sclerosis, have also been reported to sometimes present with obsessive-compulsive symptoms (OCS). Subgroups of patients with OCD show elevated proinflammatory cytokines and autoantibodies against targets that include the basal ganglia. In this conceptual review paper, the clinical manifestations, pathophysiological considerations, diagnostic investigations, and treatment approaches of immune-related secondary OCD are summarized. The novel concept of “autoimmune OCD” is proposed for a small subgroup of OCD patients, and clinical signs based on the PANDAS/PANS criteria and from recent experience with autoimmune encephalitis and autoimmune psychosis are suggested. Red flag signs for “autoimmune OCD” could include (sub)acute onset, unusual age of onset, atypical presentation of OCS with neuropsychiatric features (e.g., disproportionate cognitive deficits) or accompanying neurological symptoms (e.g., movement disorders), autonomic dysfunction, treatment resistance, associations of symptom onset with infections such as group A streptococcus, comorbid autoimmune diseases or malignancies. Clinical investigations may also reveal alterations such as increased levels of anti-basal ganglia or dopamine receptor antibodies or inflammatory changes in the basal ganglia in neuroimaging. Based on these red flag signs, the criteria for a possible, probable, and definite autoimmune OCD subtype are proposed.

scholarly journals Clinical features of paediatric acute-onset neuropsychiatric syndrome: findings from a case– control study

BJPsych Open ◽  
2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Eva Hesselmark ◽  
Susanne Bejerot
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Acute Onset ◽  
Obsessive Compulsive ◽  
Specific Symptom ◽  
Compulsive Disorder ◽  
Symptom Profile ◽  
Episodic Course ◽  
Multiple Symptoms ◽  
Control Study

BackgroundPaediatric acute-onset neuropsychiatric syndrome (PANS), an umbrella term that includes PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is suggested to be a psychiatric disorder of autoimmune aetiology. PANS is characterised by an acute onset of obsessive–compulsive disorder or restricted eating with multiple comorbid symptoms. The specificity of the PANS criteria is not fully understood.AimsTo describe a cohort of patients with PANS and to determine if PANS features relating to symptoms, onset and course are more common in PANS than in other psychiatric conditions.MethodA case–control study comparing patients with interview-confirmed PANS with patients with suspected PANS and patients with a psychiatric condition but with no suspicion of PANS. Validated and non-validated measures of symptoms, onset and episodic course were used.ResultsIllness in patients with interview-confirmed PANS featured an episodic course and multiple symptoms present at onset compared with the psychiatric controls. However, individuals with interview-confirmed PANS did not present a specific symptom profile.ConclusionsPANS may be a distinct clinical entity featuring an acute onset, an episodic course and multiple symptoms at onset.Declaration of interestNone.

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