FFFPANS and PANDAS: Sudden Onset of OCD Symptoms

No. 123; Updated October 2023 

When a child suddenly begins to have new thoughts and unusual behaviors, it can be alarming to parents and family members. If the changes occur suddenly and include unwanted recurring thoughts (obsessions), repetitive behaviors (compulsions), and/or decreased eating, your child's doctor may consider the diagnosis of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Family members can sometimes pinpoint the moment the problems started, this is not a gradual process.

PANS is thought to be triggered by exposure to one of a variety of infections or other things that can activate the immune system. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an older and more specific term that describes a sudden development of these symptoms occurring after a strep infection. The understanding of these syndromes is evolving, and doctors may have different opinions about the best assessment and treatment

In addition to obsessive and compulsive symptoms, PANS can include extreme changes in the following:

  • eating
  • worrying or anxiety
  • mood swings or depression
  • irritability, aggression, or oppositional behaviors
  • attention, memory, or learning
  • sensory or motor problems
  • sleep
  • bed wetting
  • hyperactivity
  • tics or movements

Obsessive compulsive disorder (OCD) is characterized by recurrent intense obsessions and/or compulsions that cause severe distress and interfere with day-to-day functioning. OCD generally develops more slowly over weeks or months. PANS can appear very suddenly.

It is important for parents to understand that PANS and PANDAS are rare. Children get many infections, including strep. Most who get these infections will not develop PANS and PANDAS. Most children who develop OCD symptoms do not have PANS and PANDAS. Researchers are trying to better understand the differences between PANS, PANDAS, and OCD.

Any child who has a sudden change in mood or behavior should be evaluated by a trained and qualified healthcare professional as quickly as possible. If PANS or PANDAS is suspected, it is important to obtain a comprehensive psychiatric, general medical evaluation and may also be seen by a pediatric neurologist. This evaluation will begin with a detailed interview with you and your child as well as a physical exam and may be followed by laboratory and other tests. It can be challenging to distinguish between OCD, PANS, PANDAS, and other medical conditions.

After comprehensive assessment with a qualified mental health professional, you should talk to your doctor about treatment. Most children with OCD symptoms can be treated effectively with a combination of psychotherapy, especially cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRIs) which are the most common medicines used to treat OCD. Family support and education are also central to the success of treatment. Some children with PANS or PANDAS may improve with antibiotics or Intravenous Immunoglobulin (IVIG) treatment. However, these treatments can have serious side effects, and not all studies have shown that they provide a clear benefit. Research is still ongoing; bring your questions to your doctor.

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