title: Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder.
abstract: BACKGROUND
  Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood.
  
  
  OBJECTIVE
  To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview.
  
  
  METHODS
  Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups.
  
  
  RESULTS
  Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode.
  
  
  CONCLUSIONS
  A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.
authors.affiliation: 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .|2 Department of Psychiatry, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Fern
authors.initials: F
authors.lastname: Jaspers-Fayer
authors.affiliation: 3 School of Medicine, Wayne State University , Detroit, Michigan.
authors.forename: Sang Hun Jerry
authors.initials: SHJ
authors.lastname: Han
authors.affiliation: 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .
authors.forename: Elaine
authors.initials: E
authors.lastname: Chan
authors.affiliation: 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada .
authors.forename: Katherine
authors.initials: K
authors.lastname: McKenney
authors.affiliation: 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada .
authors.forename: Annie
authors.initials: A
authors.lastname: Simpson
authors.affiliation: 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada .
authors.forename: Andrea
authors.initials: A
authors.lastname: Boyle
authors.affiliation: 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .
authors.forename: Rhonda
authors.initials: R
authors.lastname: Ellwyn
authors.affiliation: 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .|2 Department of Psychiatry, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|5 Massachusetts General Hospital , Boston, Massachusetts.|6 Harvard Medical School , Boston, Massachusetts.|7 Department of Psychiatry, BC Children's Hospital , Vancouver, British Columbia, Canada .
authors.forename: S Evelyn
authors.initials: SE
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: neuropsychiatric syndrome; obsessive-compulsive disorder; pediatric acute-onset; pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; prevalence