title: Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients.
abstract: BACKGROUND
  Abrupt, dramatic onset obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms (anxiety, mood dysregulation, irritability/aggression/oppositionality, behavioral regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms) defines pediatric acute-onset neuropsychiatric syndrome (PANS). Descriptions of clinical data in such youth are limited.
  
  
  METHODS
  We reviewed charts of 53 consecutive patients evaluated in our PANS Clinic; 47 met PANS symptom criteria but not all met the requirement for "acute onset." Patients meeting full criteria for PANS were compared with patients who had a subacute/insidious onset of symptoms.
  
  
  RESULTS
  Nineteen of 47 (40%) patients in the study had acute onset of symptoms. In these patients, autoimmune/inflammatory diseases and psychiatric disorders were common in first-degree family members (71% and 78%, respectively). Most acute-onset patients had a relapsing/remitting course (84%), prominent sleep disturbances (84%), urinary issues (58%), sensory amplification (66%), gastrointestinal symptoms (42%), and generalized pain (68%). Inflammatory back pain (21%) and other arthritis conditions (28%) were also common. Suicidal and homicidal thoughts and gestures were common (44% and 17%, respectively) as were violent outbursts (61%). Group A streptococcus (GAS) was the most commonly identified infection at onset (21%) and during flares (74%). Rates of the above-mentioned characteristics did not differ between the acute-onset group and the subacute/insidious-onset groups. Low levels of immunoglobulins were more common in the subacute/insidious-onset group (75%) compared with the acute-onset group (22%), but this was not statistically significant (p=0.06).
  
  
  CONCLUSIONS
  In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.
authors.affiliation: Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine , Palo Alto, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frankovich
authors.forename: Margo
authors.initials: M
authors.lastname: Thienemann
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pearlstein
authors.forename: Amber
authors.initials: A
authors.lastname: Crable
authors.forename: Kayla
authors.initials: K
authors.lastname: Brown
authors.forename: Kiki
authors.initials: K
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000554:Ambulatory Care Facilities; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002648:Child; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013577:Syndrome; D016896:Treatment Outcome