What is the recommended treatment approach for patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Obsessive-Compulsive Disorder (OCD)?

From the Guidelines

The recommended treatment approach for patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Obsessive-Compulsive Disorder (OCD) involves a multi-modal strategy addressing both the underlying inflammatory/immune dysfunction and the psychiatric symptoms.

Treatment Approach

Treatment should begin with addressing any underlying infection or inflammation through antibiotics if a streptococcal or other bacterial infection is identified. Common antibiotics include azithromycin (10 mg/kg daily for 5 days) or amoxicillin (40 mg/kg/day divided twice daily for 10-14 days) 1.

Psychiatric Symptoms

For the psychiatric symptoms, cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the first-line psychological treatment, typically delivered in 12-16 weekly sessions 1.

Pharmacological Treatment

Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) such as sertraline (starting at 12.5-25 mg daily, gradually increasing to 50-200 mg daily) or fluoxetine (starting at 5-10 mg daily, gradually increasing to 20-60 mg daily) are recommended 1.

Severe Cases

For severe cases with significant inflammation, immunomodulatory treatments may be necessary, including corticosteroids (prednisone 1-2 mg/kg/day for 5-7 days, then tapered), intravenous immunoglobulin (IVIG at 1-2 g/kg), or plasmapheresis 1. Some key points to consider in the treatment approach include:

• The importance of addressing underlying infections or inflammation
• The use of CBT and ERP as first-line psychological treatments
• The role of SSRIs in pharmacological treatment
• The potential need for immunomodulatory treatments in severe cases This comprehensive approach targets both the neuroinflammatory process believed to trigger PANS and the resulting OCD symptoms, recognizing that PANS represents an autoimmune or inflammatory condition affecting brain function rather than a primary psychiatric disorder.

From the Research

Treatment Approach for PANS and OCD

The treatment approach for patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Obsessive-Compulsive Disorder (OCD) involves a combination of pharmacological and psychological interventions.

• Pharmacological Interventions:
  • Selective serotonin re-uptake inhibitors (SSRIs) are commonly used to treat OCD 2, 3, 4.
  • Atypical antipsychotics, such as risperidone, may be used as an adjunct to SSRIs in treatment-resistant cases 5, 6.
• Psychological Interventions:
  • Cognitive-behavioral therapy (CBT) is an effective treatment strategy for OCD and may be used in conjunction with pharmacological interventions 2, 3, 6.
  • CBT may be particularly useful in cases where patients do not respond to initial pharmacological treatment 2, 6.
• Treatment Considerations:
  • The optimal dose of SSRIs for OCD is around 40mg fluoxetine equivalent, balancing efficacy and tolerability 4.
  • Treatment-resistant OCD may require alternative strategies, such as switching to a different SSRI or adding an antipsychotic 6.
  • Inpatient psychiatric hospitalization may be necessary in severe cases, particularly where there is a risk of dehydration or other medical complications 5.