PANDAS: behov for nasjonale retningslinjer

2021 ◽  
Vol 58 (11) ◽  
pp. 946-955
Keyword(s):  
Streptococcal Infection ◽  
Psychiatric Treatment ◽  
Case Reports ◽  
Cochrane Library ◽  
Streptococcal Infections ◽  
National Guidelines ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Post Infectious ◽  
Knowledge And Acceptance

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) was introduced in 1998. The hypothesis that acute tics and/or symptoms of obsessive-compulsive disorder (OCD) might be triggered by streptococcal infection lacks scientific support. Patients are seen by several specialists, and treatment depends on knowledge and acceptance of the condition. This article provides an overview of literature investigating proposed treatments. Method: We performed a literature search in PubMed and Cochrane Library between 1 June 2019 and 17 July 2021. Results: 14 reviews were included. Suggested treatments comprised psychiatric treatment, antibiotics, tonsillectomy and immune modulating therapy. Recommendations were largely based on case reports and uncontrolled studies. Conclusion: Few studies have been conducted on PANDAS treatment, and none were evidence-based. Cooperation between different professions and establishment of national guidelines on how to approach these children are crucial. Keywords: PANDAS, post-infectious autoimmunity, neuropsychiatry, interdisciplinary

scholarly journals The Behavior of Patients with Obsessive-Compulsive Disorder in Dental Clinics

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hala M. Elkamash ◽  
Hatem M. Abuohashish
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Case Reports ◽  
Research Question ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Case Control Studies ◽  
Obsessive Compulsive ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Compulsive Disorder

Objectives. This review documents published obsessive-compulsive disorder (OCD) cases with dental and oral conditions with potential impact on the dental procedure. The research question was, what are the psychiatric and behavioral features of people with OCD that might affect dental sessions? Methods. This review followed the PRISMA guidelines (PROSPERO registration No. CRD42020212371). Six databases (PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and PsycINFO) were screened for published clinical studies that report dental patients with obsessions or compulsions behaviors as identified by National Institute of Mental Health (NIMH). Inclusion of the studies was performed according to the eligibility criteria. The quality evaluation was carried out using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist. The results were qualitatively assessed for synthesis. Results. After elimination of duplication, 530 articles were screened, and 35 articles were evaluated for eligibility. 17 studies met the inclusion criteria (8 case reports, 5 cross-sectional studies, 1 longitudinal cohort study, and 3 case-control studies) and were included in the review. All case reports demonstrated symptoms of obsessions or compulsions such as fear of germs and contamination, aggressive thoughts, having things symmetric in perfect order, excessive cleaning or handwashing, repeatedly checking things, and compulsive counting. OCD-related behavior was assessed in the included clinical investigations using standardized protocols such as Florida Obsessive-Compulsive Inventory, Symptom Checklist-90-Revised, 4-item Corah Dental Anxiety Scale, Diagnostic and Statistical Manual of Mental Disorders, and the Crown Crisp Experimental Index. Quality assessment of the 17 included articles revealed 14 articles with low risk of bias and 3 articles with moderate risk of bias. Conclusion. The reported OCD symptoms may implement psychological difficulties during dental procedures without affecting the outcome. Although there was no contraindication for planning or performing dental treatments for a patient with OCD, dental-related procedures and protocols might be modified for successful dental appointments.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Mohammad O AL fattani ◽  
Asmaa M Al Refaie ◽  
Shuruq Hassan Alsulami ◽  
Najia Al Hojaili
Keyword(s):  
Febrile Illness ◽  
Neuropsychiatric Disorders ◽  
Age Group ◽  
Pediatric Age ◽  
Streptococcal Infections ◽  
Obsessive Compulsive ◽  
Tic Disorder ◽  
Compulsive Disorder ◽  
Pediatric Age Group ◽  
Suicidal Attempts

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a rear disease in pediatric age group which constitute a unique manifestation associated with obsessive-compulsive disorder (OCD) and tic disorder in children. However, this diagnosis has carried a lot of controversies, related mainly to its management. Here we are presenting one case of PANDAS syndrome who was treated successfully with full coarse of antibiotic for 10 days, where all his symptoms disappeared completely in subsequent days including suicidal attempts. PANDAS should be considered in children with neuropsychiatric disorders (tics, obsessive behavior etc.) especially if symptoms associated within a period of infection such as febrile illness or sore throats.

Intravenous, Pulse-Loaded Clomipramine in Body Dysmorphic Disorder: Two Case Reports

CNS Spectrums ◽  
1996 ◽  
Vol 1 (2) ◽  
pp. 54-57 ◽  
Author(s):  
Stefano Pallanti ◽  
Lorrin M. Koran
Keyword(s):  
Body Dysmorphic Disorder ◽  
Case Reports ◽  
Controlled Trial ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Dsm Iv ◽  
Surgical Treatments ◽  
Delusional Disorder Somatic Type

AbstractBody dysmorphic disorder (BDD) is characterized by excessive preoccupation with an imagined or greatly exaggerated defect in appearance, and often by related rituals or pursuit of medical or surgical treatments. The frequent comorbidity of BDD with obsessive-compulsive disorder (OCD) and the phenomenological similarities between these two disorders suggest that they may be related. BDD reportedly responds to oral clomipramine (CMI).We present here two case studies of patients meeting DSM-IV criteria for BDD with comorbid delusional disorder, somatic type, to whom we administered pulse-loaded intravenous (IV) CMI (150 mg on day 1, 200 mg on day 2). After a 4.5-day drug holiday, both patients continued on oral CMI. As reflected in modified Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, both patients' BDD improved by about one third within 4.5 days of the second IV dose. Improvement continued over 2 months on oral CMI, and comorbid major depression present in one patient remitted. By the end of 8 weeks of oral CMI, the patients' modified Y-BOCS scores had decreased about 55%, and their social functioning had markedly improved.As in OCD, pulse-loaded, IV CMI may produce a much faster response than oral CMI or selective serotonin reuptake treatment and can be well tolerated. This treatment approach to BDD deserves further study in a prospective, randomized controlled trial.

Pharmacotherapy for obessive-compulsive disorder

1998 ◽  
Vol 173 (S35) ◽  
pp. 64-70 ◽  
Author(s):  
John H. Greist ◽  
James W. Jefferson
Keyword(s):  
Monoamine Oxidase ◽  
Effective Treatment ◽  
Serotonin Reuptake ◽  
Randomised Controlled Trials ◽  
Case Reports ◽  
Controlled Trials ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Randomised Controlled

Background Pharmacotherapy for obsessive-compulsive disorder (OCD) was seldom beneficial before clomipramine, a potent selective serotonin reuptake inhibitor (SSRI), became available. Subsequent progress in pharmacotherapy for OCD has increased the possibility of effective treatment for most sufferers.Method Randomised controlled trials of pharmacotherapy for OCD were reviewed, as well as reports of beneficial pharmacotherapy found in open trials and case reports.Results SSRIs are well-tolerated by patients with OCD, even in large doses. Prose roto n erg i c augmentation is seldom helpful but antipsychotic augmentations seem beneficial for many OCD patients with comorbid tics.Conclusions Potent SSRIs are the pharmacotherapy of choice for OCD, with a more limited role reserved for monoamine oxidase inhibitors. If one SSRI is ineffective, others may be beneficial. Non-drug therapies are also important in OCD: behaviour therapy is frequently helpful but infrequently available and neurosurgery is sometimes helpful when all other treatments have failed.

scholarly journals Changes of oscillatory activity in the subthalamic nucleus during obsessive-compulsive disorder symptoms: Two case reports

Cortex ◽  
2014 ◽  
Vol 60 ◽  
pp. 145-150 ◽  
Author(s):  
Julien Bastin ◽  
Mircea Polosan ◽  
Brigitte Piallat ◽  
Paul Krack ◽  
Thierry Bougerol ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Subthalamic Nucleus ◽  
Case Reports ◽  
Oscillatory Activity ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

A mixed approach: Posttraumatic obsessive compulsive disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S411-S411
Author(s):  
R. Landera Rodríguez ◽  
M. Gómez Revuelta ◽  
M. Juncal Ruíz ◽  
O. Porta Olivares ◽  
R. Martín Gutiérrez ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Traumatic Event ◽  
Case Reports ◽  
Poor Response ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Psychotherapeutic Approach ◽  
Limited Experience ◽  
Competing Interest ◽  
Mixed Approach

IntroductionSeveral studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.ObjectivesDespite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.Material and methodsWe present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.ResultsOur limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.DiscussionDespite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.ConclusionsA mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Investigating Tourette Syndrome as a Neurologic Sequela of Rheumatic Fever

CNS Spectrums ◽  
1999 ◽  
Vol 4 (2) ◽  
pp. 62-67 ◽  
Author(s):  
Roger Kurlan
Keyword(s):  
Rheumatic Fever ◽  
Obsessive Compulsive Disorder ◽  
Tourette Syndrome ◽  
Research Evidence ◽  
Streptococcal Infection ◽  
Molecular Mimicry ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Neurologic Sequela ◽  
Immune Mediated

AbstractSydenham's chorea is currently recognized as the only neurologic sequela of rheumatic fever. Recent evidence suggests that there may be a spectrum of neurobehavioral disturbances, particularly including tics and obsessive-compulsive disorder, that develops following streptococcal infection by the process of molecular mimicry, whereby antibodies directed against bacterial antigens cross-react with brain targets. This proposed postinfectious, immune-mediated condition has been termed “pediatric autoimmune neuropsychiatric disorders after streptococcal infection” (PANDAS). This article reviews research evidence in favor and also against the PANDAS concept and discusses the implications of the hypothesis.

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