PANS: Help with a tough diagnosis

A new consensus statement from pediatric clinicians and researchers offers guidance for the often difficult diagnosis of pediatric acute-onset neuropsychiatric syndrome (PANS), including sudden-onset obsessive-compulsive disorder (OCD). The recommendations should offer particular benefit to pediatricians, other primary care providers, and child psychiatrists, who usually make the diagnosis.

The statement by the PANS Collaborative Consortium emerged from the first PANS Consensus Conference in 2013. The conference’s goals were “to clarify the diagnostic boundaries of PANS, to develop systematic strategies for evaluation of suspected PANS cases, and to set forth the most urgently needed studies in this field.” Pediatric acute-onset neuropsychiatric syndrome and its subcategory, pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), seem to be set off by infections, especially of the upper respiratory tract.

Special Report: MOC Talk

The statement details recommendations for a comprehensive diagnostic workup, which should include family and medical history; physical examination; psychiatric evaluation; symptoms and history that suggest the need for further investigation of immune function; neurologic assessment; assessment of somatic symptoms (including possible sleep evaluation); genetic evaluation; laboratory tests; and infectious disease evaluation.

The authors of the consensus statement emphasize the importance of considering alternative medical explanations for neuropsychiatric symptoms and note that psychosocial trauma or stress as an explanation for such symptoms should be “a diagnosis of exclusion.” Referral to a neurologist or rheumatologist, while possibly helpful for some patients, should focus on specific concerning signs or symptoms because subspecialists may not have experience in evaluating psychiatric symptoms. 

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