Emilie Meyer
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) are childhood conditions that can cause suicidal ideation in children. PANDAS is a subset of PANS, but is specifically linked to a strep bacterial infection. Both conditions are characterised by the sudden onset of OCD and/or severe eating restrictions, along with other cognitive, behavioural, or neurological symptoms. According to the PANDAS Network, a research non-profit, approximately one in 200 children are affected by PANDAS. However, it is unclear how many children have died by suicide as a result of PANDAS or PANS.
| Characteristics | Values |
|---|---|
| Self-harming behaviors in children with PANS | High frequency, violent methods, early onset, and overlap with suicidal tendencies |
| Suicidality in children under 12 years old | Limited knowledge, but recent research suggests suicidality can occur before age 15, and even as early as 7 years old |
| Self-harm as a risk factor for suicide | Early onset of self-harm is a risk factor for future suicide |
| PANS/PANDAS treatment | Antibiotics and close monitoring |
| Global suicide rates among young people aged 15-19 | Suicide was the fourth leading cause of death among young males and the third for young females in 90 countries |
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What You'll Learn
PANDAS is a subset of PANS, triggered by strep infections
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a subset of PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome. PANDAS is triggered by strep infections, specifically Group A streptococcal infections, such as strep throat or scarlet fever. It is believed that approximately one in 200 children are affected by PANDAS, according to the PANDAS Network, a research nonprofit for the disease.
PANDAS is characterized by a sudden onset or worsening of symptoms, including obsessive-compulsive disorder (OCD), tics, and other neuropsychiatric symptoms. The symptoms of PANDAS are typically intense and can include compulsions, obsessions, anxiety, and mood changes. They can also include impulsive dangerous behaviour, homicidal ideation, and life-threatening violence. In some cases, PANDAS can lead to suicidal thoughts and behaviour.
PANDAS is believed to occur when a child's immune system produces antibodies to fight a strep infection, but these antibodies also mistakenly attack healthy cells in other tissues, including the brain. This can lead to the psychological and neurological symptoms associated with PANDAS. PANDAS typically affects children between the ages of 3 and puberty, and symptoms can vary widely from child to child.
PANS, on the other hand, is triggered by infections other than strep, such as Lyme disease or influenza, as well as immune system issues or environmental factors. PANS is diagnosed by a healthcare provider using specific criteria, including the sudden onset of OCD or severely restricted food intake, at least two other neuropsychiatric symptoms, and a history of a strep infection within three months of symptom onset.
While PANDAS is a specific subtype of PANS associated with strep infections, both conditions are characterized by a sudden and severe onset of symptoms and can have similar comorbid symptoms. However, PANDAS has five distinct criteria for diagnosis, including abrupt "overnight" OCD or disabling tics, a relapsing-remitting episodic symptom course, young age at onset, the presence of neurological abnormalities, and a temporal association between symptom onset and Group A strep infection.
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PANDAS is a rare and complex illness
PANDAS is a subtype of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), a group of autoimmune diseases that affect the brain. PANDAS is specifically associated with an infection from streptococcal (strep) bacteria, such as strep throat or scarlet fever. The symptoms of PANDAS can be intense and may come and go over time, with some children experiencing episodic symptom courses. In some cases, PANDAS can become a chronic autoimmune disorder, making early diagnosis and treatment crucial.
The symptoms of PANDAS typically develop suddenly and can include anxiety or depression, bedwetting, changes in mood or personality, difficulty sleeping, disinterest in food, and symptoms similar to attention-deficit/hyperactivity disorder (ADHD). These symptoms can vary widely from child to child, and the onset of PANDAS can be challenging to diagnose as there is no specific test. Healthcare providers must rule out many other conditions and perform a thorough evaluation of the child's symptoms.
Treatment for PANDAS focuses on addressing the underlying cause, managing symptoms, and supporting the immune system. Antibiotics are often used to treat the strep infection, and cognitive behavioural therapy (CBT) can help children manage mental and emotional difficulties. Intravenous immunoglobulin (IVIG) therapy has also proven effective in treating PANDAS, although health insurance claims are often denied. While most children who receive treatment recover completely, the road to healing can be long and emotional for families.
The complex nature of PANDAS, combined with its rarity, can make it challenging to diagnose and treat effectively. However, early intervention and comprehensive treatment plans are crucial to reducing the duration and intensity of symptoms and preventing potential permanent psychological and neurological issues.
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Symptoms of PANDAS appear overnight, but recovery is slow
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a rare condition that affects children. It is believed that approximately one in 200 children are affected by PANDAS. The condition is characterised by a sudden onset of symptoms, including obsessive-compulsive behaviours, tics, anxiety, mood changes, and other neurological and psychological issues.
The symptoms of PANDAS can indeed appear overnight, as reported by many parents of children with the condition. One mother shared that her son, who was 11 at the time, woke up one day with scary thoughts of suicide. Another mother shared a similar story of losing her son to the disease. These sudden and intense symptoms can be extremely distressing for both the child and the family.
PANDAS is believed to be triggered by a strep infection, where the immune system's response to the infection causes it to mistakenly attack healthy brain cells, leading to the onset of PANDAS symptoms. While the exact cause is still being researched, this theory is supported by the fact that many children with PANDAS have a history of strep infections.
While the symptoms of PANDAS can appear suddenly and intensely, the recovery process is typically slow and gradual. With proper treatment, most children with PANDAS can make a full recovery over time. Treatment options include antibiotics to address the underlying strep infection, cognitive behavioural therapy, and habit reversal training for tics. In more severe cases, extreme procedures such as IVIG or plasmapheresis may be considered to reset the immune system.
It is important to note that PANDAS can become a chronic disorder if left untreated. Therefore, early diagnosis and treatment are crucial to ensure the best chances of recovery. If you suspect your child is displaying symptoms of PANDAS, it is important to seek medical advice as soon as possible.
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PANDAS can lead to suicidal ideation and self-harm
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a rare and complex paediatric disorder that can first appear in children between the ages of 3 and puberty. It is believed that PANDAS affects approximately one in 200 children.
PANDAS is an autoimmune disorder that can lead to frightening behaviour in children. Suicidality has been reported in 40% of patients diagnosed with PANDAS. A study focused on a 9-year-old girl with PANDAS who was obsessed with the idea of killing herself. She had no reason for wanting to die but felt that she was unable to escape the thought. She had already attempted suicide several times but was stopped by family members.
PANDAS can cause impulsive dangerous behaviour, homicidal ideation, and life-threatening violence. The symptoms of PANDAS can appear suddenly, but they typically take time to subside, even with treatment. Many families endure a long and emotional journey before they start to feel a sense of normalcy again.
In some cases, PANDAS can lead to chronic autoimmune disorders, which is why early diagnosis and treatment are crucial. Antibiotics are the most effective treatment for PANDAS, as they can treat the underlying strep infection. It is also important to replace the child's toothbrush during and after the course of antibiotics to avoid re-infection.
PANDAS can be difficult to diagnose, and it is often dismissed by doctors as a made-up condition. This can delay treatment and lead to tragic consequences. It is important for parents to trust their instincts and seek a second opinion if they believe their child may have PANDAS.
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Treatment for PANDAS includes antibiotics and steroids
While the exact number of children who have died by suicide due to PANDAS is unclear, there are several first-hand accounts of children taking their own lives after experiencing symptoms associated with the disorder. PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a rare and complex autoimmune disorder that can lead to frightening behaviour and suicidal thoughts in children.
Treatment for PANDAS typically includes antibiotics and steroids, with the goal of treating the underlying strep infection and reducing inflammation in the brain. Here is some more information on these treatments:
Antibiotics
Antibiotics are a crucial part of treating PANDAS, as they target the underlying strep infection. The specific type of antibiotic used depends on the type of infection. For example, "beta-lactams" such as penicillin, amoxicillin, and cephalosporins are effective against GAS infections. Azithromycin, erythromycin, and clindamycin are also used to treat GAS infections, but regional resistance may be a factor. Antibiotics can lead to a quick response, with full or partial remission of OCD, anxiety, and other comorbid symptoms of PANDAS within 24-48 hours. However, a more typical response time is a week or two of therapy. If there is no improvement after 10-14 days, an alternative antibiotic may be considered for an additional treatment period.
Steroids
Steroids are used to reduce inflammation in the child's brain and have been shown to reduce the severity of symptoms in patients with Sydenham's chorea. Active infections are treated with steroids, but it is important to note that some children with PANDAS may experience a worsening of tics or aggression with their use. Therefore, it is crucial to discuss the potential benefits and risks of steroids with a healthcare provider.
In addition to antibiotics and steroids, other treatments for PANDAS may include IVIG (intravenous immunoglobulin), plasma exchange (TPE), tonsillectomy, cognitive behaviour therapy (CBT), and immunomodulatory therapies. Probiotics are also recommended to maintain healthy gut bacteria, which can be affected by antibiotic use. While these treatments can be effective, early diagnosis and timely treatment are crucial to ensuring positive outcomes and complete recovery.
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Frequently asked questions
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a subset of PANS, a childhood condition characterized by the sudden onset of obsessive-compulsive symptoms (OCD) and/or eating restrictions following a bacterial or viral infection.
Symptoms include anxiety, irrational fears, separation anxiety, panic attacks, temper tantrums, depression, suicidal ideation, aggression, sleep disturbances, and more.
It is believed that approximately one in 200 children are affected by PANDAS, with an average age of onset between 4 and 10 years old.
Antibiotics are the primary treatment for PANDAS. Steroids can also be used to help ease inflammation in a child's brain and reduce symptoms. Cognitive Behaviour Therapy (CBT) can also help children cope with the psychological symptoms of PANDAS.
There is limited knowledge and research regarding suicidality in children under 12 years old with PANDAS. However, suicidality has been reported in 40% of patients diagnosed with PANDAS, and it is believed that approximately one in 200 children are affected by the disorder.
