Journal
JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY
Volume 27, Issue 4, Pages 332-341Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/cap.2016.0031
Keywords
obsessive-compulsive disorder; pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; pediatric acute-onset; neuropsychiatric syndrome; prevalence
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Funding
- Michael Smith Foundation for Health Research (MSFHR)
- BC Provincial Health Services Authority (PHSA)
- Canadian Institutes of Health Research (CIHR)
- BC Children's Hospital (BCCH) Research Institute Summer Student Research Program
- MSFHR
- BCCH Pediatric Mental Health Fellowship
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Background: Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood. Objectives: To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview. Methods: Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self-and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups. Results: Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode. Conclusion: A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.
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