Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part I-Psychiatric and Behavioral Interventions
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OBJECTIVE: This article outlines the consensus guidelines for symptomatic treatment for children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcal Infection (PANDAS). METHODS: Extant literature on behavioral, psychotherapeutic, and psychopharmacologic treatments for PANS and PANDAS was reviewed. Members of the PANS Research Consortium pooled their clinical experiences to find agreement on treatment of PANS and PANDAS symptoms. RESULTS: Current guidelines result from consensus among the Consortium members. CONCLUSION: While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child's presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.
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Tics may respond to a variety of medications that decrease or block dopamine.
“Tics may respond to a variety of medications that decrease or block dopamine.34,35”
From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [34]
The Tics section says several antipsychotics may be used for severe tics and names agents approved for Tourette syndrome or supported by evidence for treating tics. It does not say that these medications work by decreasing or blocking dopamine, and it limits antipsychotic use to severe tics. (LLM, conf=0.86)
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- Authors
- Thienemann, M., Murphy, T., Leckman, J., Shaw, R., Williams, K., Kapphahn, C., Frankovich, J., Geller, D., Bernstein, G., Chang, K., Elia, J., & Swedo, S.
- Affiliations
- Stanford University (US)
- University of South Florida St. Petersburg (US)
- Yale University (US)
- Massachusetts General Hospital (US)
- Harvard University (US)
- University of Minnesota (US)
- Alfred I. duPont Hospital for Children (US)
- National Institute of Mental Health (US)
- Corresponding author
- Thienemann, Margo
- ORCID
- Venue
- Journal of Child and Adolescent Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2017-09
- Volume
- 27
- Issue
- 7
- Pages
- 566-573
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- PMC
- PMC5610394
- OpenAlex
- W2738337914
- Cited by
- 149
- References
- 48
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 24 · 2023: 19 · 2022: 17 · 2021: 17 · 2020: 10 · 2019: 23 · 2018: 12 · 2017: 3
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Child and Adolescent Psychopharmacology (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (R25MH077823)
- Topics
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- pediatric acute-onset neuropsychiatric syndrome, PANS, PANDAS, streptococcal infection, psychiatric treatment, behavioral interventions, psychotherapy, psychopharmacology, psychotropic drugs, medication adherence, treatment guidelines
- MeSH terms
- Acute Disease, Autoimmune Diseases, Behavior Therapy, Child, Child Behavior Disorders, Child, Preschool, Humans, Streptococcal Infections, Syndrome, Disease Management, Immunomodulation, Neurodevelopmental Disorders
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