Article2017

Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder

Fern Jaspers‐Fayer · Sang Hun Jerry Han · Katherine S. McKenney · Andrea Boyle · Rhonda Ellwyn · S. Evelyn Stewart

60 citations0/0 files storedJournal of Child and Adolescent Psychopharmacology

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Obsessive-Compulsive Spectrum Disorders Streptococcal Infections and Treatments Autoimmune Neurological Disorders and Treatments

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. OBJECTIVES: 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. CONCLUSION: 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.

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References

1989The Yale-Brown Obsessive Compulsive Scale 2008The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication 1998Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases 2008Meta-Analysis of the Symptom Structure of Obsessive-Compulsive Disorder 2011Practice Parameter for the Assessment and Treatment of Children and Adolescents With Obsessive-Compulsive Disorder 1989Obsessive-compulsive disorder in children and adolescents 2009Decreased family accommodation associated with improved therapy outcome in pediatric obsessive–compulsive disorder.2005Association Between Streptococcal Infection and Obsessive-Compulsive Disorder, Tourette's Syndrome, and Tic Disorder

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