A new psychiatric disorder is emerging among teens and it is baffling the medical community.  The sudden onset neuropsychiatric syndrome, also called PANS, is a sudden mental and neurological illness that seems to strike only teenagers and has no certified known origin or cause. 

Only recently, doctors have had to confront the baffling illness in teenagers who presented with extreme psychosis and some physical symptoms for which there is no apparent cause or cure.  

Defined as a rapid onset Obsessive compulsive disorder type, some scientists attribute the malady to a streptococcal infections, or an immune response to some yet undefined agent or pathogen.  The pathogens seem to affect the basal ganglia in the brain, which is an area fundamental for a spate of vital functions, including cognition, emotion and motory functions.  

Because it is such a new disease, the symptoms classification is rather new and rudimentary, with new symptoms and presentation being added as new cases occur.  What is indisputable, however, is the sudden and frightening onset, which is defined as rise in anxiety or depression that soon reaches aggressive and hallucinatory peaks, and can devolve in behavioral regression and even convulsions.  Physical symptoms include frequent need to urinate, a wide array of somatic symptoms, including a feeling that the brain is affected, and inability to sleep normally. 

There are diseases that present with similar symptoms, so evaluation needs to exclude those, such as lupus, encephalomyelitis and Tourette's.  But after those are ruled out, the problem is the management of the disease, since there is no definite cure.  Only a very dangerous class of psychiatric medication seems to bring some relief to the sufferers, but the side effect often scare parents from choosing that option.  Only a handful of clinics in the US handles PANS and offer the potent cocktail of psychotropic medication, with a waiting list of more than 5 months.  

To parents who have never heard of the disease, the onset of the syndrome is terrifying.  One of the new therapies considered for the treatment is one that targets errant antibodies with IV immunoglobulin, which is intended to reduce the obsessive compulsive behaviors in the sufferers by stopping immune reactions that attack the brain and nerves.  The Immunoglobulin targets those harmful antibodies that are causing the immune reaction which is believed to underlie the psychiatric and neurological symptoms. 

One of the greatest danger in PANS sufferers is misdiagnosis.  A teen in San Jose, California, spent one year in and out of psychiatric wards until her illness was properly diagnosed.  

Because the infection which is believed to cause the illness is not apparent, the resulting effect on the brain is not detected until the full blown symptoms appear.  The infection is believed to cause swelling of the brain, which then leads to the spate of symptoms that characterize PANS.  

Some in the medical community posit that the disease is a construction to extort money from frigthened parents, and is a non-existant syndrome. Those medical pundits believe that a placebo trial should be undertaken to show that the syndrome is not organic nor caused by an infection.  

However, doctors at the National Institute of Mental Health, or NIMH, in the United States, who have been tracking the illness since the 1980's, believe that the disease is all too real.  However, they also believe that it is primarily a medical problem with secondary psychiatric problems, and that it has to be dealt with first as a medical syndrome with collateral psychiatric symptoms. 

The cases vary in intensity from mild to severe.  In some cases the symptoms clear out quickly, in others they are believed to last for years. 

In addition, more cases recently seem to afflict younger children.  The Harvard Medical School research believes that antibiotics can clear the problem if administered as soon as the psychiatric symptoms occur.  They believe the disease was first detected in 1998, but they also believe that not only Strep A can cause it but also other infectious organisms as of yet unclassified. 

An important resource link from the Institute of Pediatrics and Therapeutics on PANS is available here: http://ocfoundation.org/uploadedfiles/MainContent/About_OCD/PANDAS%20to%20PANS%20-%20Final%20form%20for%20Pediatrics%20%20Therapeutics%202012.pdf

Source: NIMH/ Harvard Health/Medical school: 5.2.14

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