title: Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype.
abstract: OBJECTIVE
  Pediatric acute-onset neuropsychiatric syndrome (PANS) is a subtype of obsessive compulsive disorder (OCD) marked by an abrupt onset or exacerbation of neuropsychiatric symptoms. We aim to characterize the phenotypic presentation of youth with PANS.
  
  
  METHODS
  Forty-three youth (ages 4-14 years) meeting criteria for PANS were assessed using self-report and clinician-administered measures, medical record reviews, comprehensive clinical evaluation, and laboratory measures.
  
  
  RESULTS
  Youth with PANS presented with an early age of OCD onset (mean=7.84 years) and exhibited moderate to severe obsessive compulsive symptoms upon evaluation. All had comorbid anxiety and emotional lability, and scored well below normative means on all quality of life subscales. Youth with elevated streptococcal antibody titers trended toward having higher OCD severity, and presented more frequently with dilated pupils relative to youth without elevated titers. A cluster analysis of core PANS symptoms revealed three distinct symptom clusters that included core characteristic PANS symptoms, streptococcal-related symptoms, and cytokine-driven/physiological symptoms. Youth with PANS who had comorbid tics were more likely to exhibit a decline in school performance, visuomotor impairment, food restriction symptoms, and handwriting deterioration, and they reported lower quality of life relative to youth without tics.
  
  
  CONCLUSIONS
  The sudden, acute onset of neuropsychiatric symptoms, high frequency of comorbidities (i.e., anxiety, behavioral regression, depression, and suicidality), and poor quality of life capture the PANS subgroup as suddenly and severely impaired youth. Identifying clinical characteristics of youth with PANS will allow clinicians to diagnose and treat this subtype of OCD with a more strategized and effective approach.
authors.affiliation: 1 Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine , Tampa, Florida.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.forename: Priyal D
authors.initials: PD
authors.lastname: Patel
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.forename: Allison
authors.initials: A
authors.lastname: Kennel
authors.forename: P Jane
authors.initials: PJ
authors.lastname: Mutch
authors.forename: E Carla
authors.initials: EC
authors.lastname: Parker-Athill
authors.forename: Camille E
authors.initials: CE
authors.lastname: Hanks
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.forename: Megan D
authors.initials: MD
authors.lastname: Toufexis
authors.forename: Gul H
authors.initials: GH
authors.lastname: Dadlani
authors.forename: Carina A
authors.initials: CA
authors.lastname: Rodriguez
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D010641:Phenotype; D011019:Pneumonia, Mycoplasma / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D057566:Self Report; D013577:Syndrome; D020323:Tics / Q000175:diagnosis / Q000209:etiology / Q000523:psychology