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Review
. 2017 Sep;27(7):566-573.
doi: 10.1089/cap.2016.0145. Epub 2017 Jul 19.

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions

Margo Thienemann  1 , Tanya Murphy  2 , James Leckman  3 , Richard Shaw  1 , Kyle Williams  4 , Cynthia Kapphahn  1 , Jennifer Frankovich  1 , Daniel Geller  5 , Gail Bernstein  6 , Kiki Chang  1 , Josephine Elia  7 , Susan Swedo  8
Affiliations
Review

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions

Margo Thienemann et al. J Child Adolesc Psychopharmacol. 2017 Sep.

Abstract

Objective: This article outlines the consensus guidelines for symptomatic treatment for children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcal Infection (PANDAS).

Methods: Extant literature on behavioral, psychotherapeutic, and psychopharmacologic treatments for PANS and PANDAS was reviewed. Members of the PANS Research Consortium pooled their clinical experiences to find agreement on treatment of PANS and PANDAS symptoms.

Results: Current guidelines result from consensus among the Consortium members.

Conclusion: While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child's presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.

Keywords: consensus guidelines; pediatric acute-onset neuropsychiatric syndrome; pediatric autoimmune neuropsychiatric syndrome associated with streptococcal infection; psychotherapy.

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Conflict of interest statement

T.M. reports grants from Auspex Pharmaceuticals grants from National Institute of Mental Health, Shire Pharmaceuticals, Pfizer, Inc., F. Hoffmann-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Biosciences, Psyadon Pharmaceuticals, and PANDAS Network, and personal fees from International OCD Foundation, Tourette Syndrome Association. J.L. “I do not consider that I have any conflicts of interest with regard to the guidelines. That said, here is what JAACAP requires that I report: J.F.L. has received grant or research support from the National Institutes of Health, the UBS Optimus Foundation, and the Open Road Alliance. He has served on the advisory boards of the Brain and Behavior Research Foundation, Fondazione Child, the European Multicentre Tics in Children Studies, and How I Decide. He has authored the Yale Global Tic Severity Scale assessment tool, which is open access. He has received honoraria from the European Society for the Study of Tourette Syndrome and the Brazilian Psychiatric Association. He has received royalties from John Wiley and Sons, McGraw Hill, and Oxford University Press. He has received travel expenses from the University of Illinois–Chicago, Cornell Weill Medical College, the Medical University of South Carolina, Rutgers University, the British Academy, and the Brazilian Psychiatric Association. He has received additional support from Anne Çocuk Eğitim Vakfi (AÇEV; Mother Child Education Foundation) and private donors.” K.C. is an unpaid consultant for GSK, Lilly, and BMS. He is on the DSMB for Sunovion. In the past 3 years, he has received research support from GSK and Merck and has been a consultant for Actavis and Janssen. Remaining authors do not have any conflict of interest.

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