Pediatric Acute-onset Neuropsychiatric Syndrome

from Wikipedia, the free encyclopedia

As a Pediatric Acute-onset Neuropsychiatric Syndrome ( PANS ) is a rapid-onset systemic neurological disease with physical and psychiatric symptoms referred. The first manifestation is always in childhood or adolescence. A chronically progressive , sometimes fluctuating course with a lifelong illness is possible.

Characteristics

PANS is characterized by a strong beginning in children and adolescents. The neurological syndrome presents itself with thought disorders and behavioral abnormalities (especially from the compulsive spectrum ) as well as motor symptoms and / or tics as key symptoms , accompanied by various neurological abnormalities. The time of the onset of PANS is assigned to childhood and early adolescence, but if it becomes chronic there is a possibility of lifelong persistence . In the field of adult medicine, the Post-Inflammatory Brain Syndrome (PIBS) also describes a structurally analogous syndrome.

backgrounds

discovery

PANS was defined and researched at the world's largest research institute for mental illness, the US National Institute of Mental Health (NIMH), a sub-agency of the US Department of Health, as part of PANDAS research. The criteria for PANS are a further development of those of PANDAS, a streptococcus-specific form of PANS that has been known since the 1990s.

causes

PANS is initially a purely clinical diagnosis, the exact pathophysiological causes of which have not yet been fully elucidated. In some cases it appears to be the result of an infection with bacteria or viruses (e.g. streptococci, mycoplasma, borrelia) or other pathogens. Certain metabolic disorders and genetic changes are also suspected to trigger PANS. Changes in inflammation markers ( e.g. neopterin and TNF-α ) and metabolic products (e.g. kynurenine ) are also described. Research into the causes and definition of PANS syndrome is ongoing.

It is assumed that immunological processes act on structures of the brain , especially in the area of ​​the basal ganglia . Research cites chorea minor as a prototypical pathogenic mechanism , with the difference that in PANS the psychiatric symptoms dominate. As a result, there are behavioral changes and motor disorders as well as thought disorders and obsessive-compulsive symptoms with a sudden, often fulminant onset, which if left untreated can become chronic and persist for life. Some of the cases of obsessive-compulsive disorder and tic disorder in adults may also be the result of a PANS / PANDAS syndrome acquired in childhood. Early, consistent treatment is therefore advocated by some researchers in order to avoid chronification. Pathomechanically analogous processes can also be found in other infectious or post-infectious neuropsychiatric syndromes such as anti-NMDA receptor encephalitis , systemic lupus (SLE) or post-inflammatory brain syndrome (PIBS).

Further research

Research into PANS is still ongoing, particularly with regard to etiology , therapy and prognosis . The question of whether tic and obsessive-compulsive disorder occurring for the first time in adulthood can be triggered by reactions to the body's own antibodies or to what extent dyfunctions of the immune system are involved in the development of tic disorders is still being researched. Corresponding first indications of this can be found in immunological studies.

Terminology (PANS vs. PANDAS)

Before the definition of PANS came the discovery of PANDAS in the 1990s , which is now considered to be a sub-category of PANS caused by streptococci. PANS and PANDAS therefore share very similar diagnostic criteria, but PANS does not necessarily have to be caused by a streptococcal infection. The reason for the introduction of the PANS category was that there was increasing evidence from research that a more decisive factor than a certain pathogen could be the presence of certain immunological factors in the patient's brain. PANS therefore subsumes infectious triggers under the name PITANDS on the one hand, and non-infectious reasons on the other, such as B. Metabolic disorders in question. PANDAS is a subgroup of PITANDS. It is assumed that the PANS syndrome may also be caused by mycoplasmas and other pathogens. Various pathogens and genuinely immunological phenomena as possible causes of PANS are in the scientific discussion. The question of a possible genetic vulnerability that can pave the way for the outbreak of the PANS syndrome is still the subject of scientific research. In Europe, the same pathogenic mechanism is also being researched under the name dopamine (post-streptococcal) related autoimmune encephalitis . Due to earlier controversies in scientific circles, the PANS syndrome can also be found in research under the name CANS (Childhood Acute Neuropsychiatric Symptoms). This term, which is little known outside of research and introduced by a non-governmental psychiatric working group, is not in use in public.

Diagnosis and course

The main symptoms (necessarily with a fulminant to foudroyant beginning) correspond to the picture of a dysfunction of the basal ganglia . A spontaneous, rapid onset in childhood and adolescence, often in close proximity to a previous infection, as well as an intermittent course is essential for the diagnosis.

The following diagnostic criteria currently apply (as of 2017):

Sudden onset of at least two of the following symptoms:

Further neurological and / or neuropsychiatric symptoms , of which at least two must be present, lead to the diagnosis "PANS":

  • Movement and balance disorders
  • Sensory hypersensitivity
  • anxiety
  • Emotional lability and / or depression
  • Irritability, aggression and / or behavior inappropriate (rebellious) for the situation
  • Backward development in behavioral development / maturity (in children and adolescents)
  • Deterioration in school, study or work performance
  • Enuresis
  • Disintegration of the handwriting
  • REM sleep disorders
  • Baseless outbursts of anger
  • Development of cognitive deficits
  • Sensory and / or motor abnormalities of various kinds (including deterioration in fine motor skills)
  • Sleep disorders (possibly also reversal of the day / night rhythm) as well as disorders of REM sleep
  • Somatic symptoms such as a. Pain
  • Other neurological-psychiatric abnormalities such as separation fears, cognitive deficits, memory problems, etc. Ä.

Additional criterion:

treatment

Since the PANS syndrome and its subgroups (PITANDS / PANDAS) are still the subject of research, there were no generally recognized guidelines for treatment for a long time. In July 2017, a three-part treatment guideline was published in a special edition of the Journal of Child and Adolescent Psychopharmacology for the first time by consensus of all noteworthy PANS researchers in the USA . The guideline includes:

The National Institute of Mental Health described immune-based treatment options and antibiotic therapies years ago. If a bacterial trigger is proven, prophylactic antibiotics can be effective in preventing further attacks. This research, especially driven by Tanya Murphy at the University of South Florida , has not yet been completed, but antibiotic prophylaxis is already of importance in practice, especially in PANDAS cases. Study results are available specifically for the PANDAS subgroup. Early treatment, symptomatic as well as causal, is also recommended by the new guidelines in order to avoid chronification, as has been described for a long time.

Situation in Germany

The European guideline for Tourette syndrome and other tic disorders ( European clinical guidelines for Tourette syndrome and other tic disorders ) has taken PANS-PANDAS into account since 2011. The German Society for Child and Adolescent Psychiatry names PANS in its treatment guidelines for OCD (2007) pandas syndrome and the need to determine the antistreptolysin - titer in children and adolescents with newly broken-compulsive disorder, who have undergone recently an infection allegedly caused by streptococci. The S3 guideline on obsessive-compulsive disorder in adults mentions the PANS subgroup PANDAS as a possible, rare reason for symptoms from the obsessive-compulsive spectrum, but without addressing any therapeutic consequences.

State of research

At the beginning of 2017, the facts listed above were reviewed in a joint review by the Pandas Network (Menlo Park, California), the University at Buffalo (Buffalo, New York) and the Departments of Pediatrics and Psychiatry of the University of South Florida (St. Petersburg, Florida ), approved.

Web links

Individual evidence

  1. ↑ PANS Diagnostic Criteria, Chapter 4, PANS / PANDAS Physicians Network (as of July 2017). Retrieved July 19, 2017
  2. ↑ Susan E. Swedo, Jennifer Frankovich, Tanya K. Murphy: Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2017.0042 .
  3. ↑ N. Niedermeier and others: Obsessive spectrum diseases. In: Psychotherapy. Volume 3, Issue 2, 1998.
  4. ↑ Michael B. First: DSM 5 - Obsessive Compulsive Spectrum Disorders Conference, 2006. ( Memento from January 8, 2015 in the web archive archive.today ) American Psychiatric Association, DSM-5 Development. (accessed September 21, 2012).
  5. ↑ Michele Fornaro et al .: Obsessive-compulsive disorder and related disorders: a comprehensive survey. In: Annals of General Psychiatry. 8, 2009, p. 13. doi: 10.1186 / 1744-859X-8-13 .
  6. ↑ PANS Diagnostic Criteria, Chapters 1 to 4, PANS / PANDAS Physicians Network (as of July 2017). Accessed July 19, 2017
  7. ↑ a b c Denise Calaprice, Janice Tona u. a .: A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2016.0105 .
  8. ↑ Souhel Najjar, Daniel M Pearlman, Kenneth Alper and others: Neuroinflammation and psychiatric illness. In: Journal of Neuroinflammation. 2013, p. 10, doi: 10.1186 / 1742-2094-10-43 .
  9. ↑ Andrew Mitelman: Treatment & Further Research into PANDAS / PANS. In: What is PANDAS. Massachusetts General Hospital OCD and Rilated Disorders Program, 2012.
  10. ↑ Janice Wood, John M. Grohol: New Syndrome Expands on Possible Causs of Sudden Onset OCD in Kids . 2012.
  11. ^ S. Jeff: Can an infection suddenly cause OCD? Harvard Health Publication, Feb. 2012.
  12. ↑ National Institute of Mental Health, Research Program, website source.Retrieved August 17, 2013.
  13. ^ Jeff Szymanski: Can an infection suddenly cause OCD? Harvard Health Blog, Feb 2012.
  14. ^ Germana Moretto, Pasquini Massimo et al.: What every psychiatrist should know about PANDAS: a review. Department of Psychiatric Sciences and Psychological Medicine, "Sapienza" University of Rome. In: Clinical Practice and Epidemiology in Mental Health. 2008.
  15. ^ I. Cabo López, PJ García Ruiz Espiga, A. Herranz Bárcenas, I. Bustamante de Garnica: PANDAS: adult variant. In: Neurologia. 25 (1), Jan-Feb 2010, pp. 63-65.
  16. ↑ Alasdair Timothy Llewelyn Rathbone et al: A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the `` post-inflammatory brain syndrome '' PIBS. In: Brain, Behavior, and Immunity. 46, 2015, pp. 1–16.
  17. ↑ TK Murphy, PD Patel, JF McGuire et al .: Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype. In: J Child Adolesc Psychopharmacol. 25 (1), Feb 2015, pp. 14-25. doi: 10.1089 / cap.2014.0062
  18. ↑ Entry on Pediatric Acute-onset Neuropsychiatric Syndrome in Flexikon , a Wiki of the DocCheck company , accessed on September 4, 2014.
  19. ^ J. Frankovich, M. Thienemann, S. Rana, K. Chang: Five youth with pediatric acute-onset neuropsychiatric syndrome of differing etiologies. In: J Child Adolesc Psychopharmacol. 25 (1), Feb 2015, pp. 31-37. doi: 10.1089 / cap.2014.0056 .
  20. ↑ H. Umit Luleyap, Dilge Onatoglu, M. Bertan Yilmaz et al .: Association between pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections disease and tumor necrosis factor-α gene − 308 g / a, −850 c / t polymorphisms in 4-12- year-old children in Adana / Turkey. In: Indian J Hum Genet. 19 (2), Apr-Jun 2013, pp. 196-201. doi: 10.4103 / 0971-6866.116116 .
  21. ^ Antonella Macerollo and Davide Martino: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): An Evolving Concept. In: Tremor Other Hyperkinet Mov (NY). 2013; 3: tre-03-167-4158-7.
  22. ↑ B. Maini, M. Bathla, GS Dhanjal et al .: Pediatric autoimmune neuropsychiatric disorders after streptococcus infection. In: Indian J Psychiatry. 54 (4), Oct 2012, pp. 375-377, doi: 10.4103 / 0019-5545.104827 . PMID 23372243
  23. ^ Dan J. Stein: Obsessive-compulsive disorder. In: The Lancet . Vol 360, August 3, 2002.
  24. ↑ SE Swedo, HL Leonard, JL Rapoport: The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal infection (PANDAS) Subgroup: Separating Fact From Fiction. In: Pediatrics . Vol. 113, April 2004.
  25. ^ B. Coffey, N. Wieland: Tics, anxiety, and possible PANDAS in an adolescent. In: J Child Adolesc Psychopharmacol . 17 (4), Aug 2007, pp. 533-538.
  26. ↑ D. Marconi, L. Limpido, I. Bersani et al .: PANDAS: a possible model for adult OCD pathogenesis. In: Riv Psichiatr. 44 (5), Sep-Oct 2009, pp. 285-298.
  27. ↑ Michael Jenike, Susan Dailey: Sudden and Severe Onset OCD - Practical Advice for Practitioners and Parents. International OCD Foundation, 2012.
  28. ↑ N. Konuk, IO Tekın, U. Ozturk et al: Plasma Levels of Tumor Necrosis Factor-Alpha and Interleukin-6 in Obsessive Compulsive Disorder. In: Mediators of Inflammation. Volume 2007, Article ID 65704, PMC 1847475 (free full text)
  29. ^ Jeff Szymanski: Can an infection suddenly cause OCD? Harvard Health Blog, Feb 2012.
  30. ↑ Alasdair Timothy Llewelyn Rathbone et al: A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the `` post-inflammatory brain syndrome '' PIBS. In: Brain, Behavior, and Immunity. 46, 2015, pp. 1–16.
  31. ↑ Camila P. Almeida-Suhett et al: Temporal Course of Changes in Gene Expression Suggests a Cytokine-Related Mechanism for Long-Term Hippocampal Alteration after Controlled Cortical Impact. In: Journal of Neurotrauma. Vol. 31, Issue. 7, pp. 683-690. doi: 10.1089 / new.2013.3029
  32. ↑ TK Murphy, DM Gerardi, JF Leckman: Pediatric Acute-Onset Neuropsychiatric Syndrome. In: Psychiatr Clin North Am. 37 (3), Sep 2014, pp. 353-374. doi: 10.1016 / j.psc.2014.06.001 .
  33. ↑ G. Vitaliti, RR Trifiletti, R. Falsaperla: A new clinical feature associated with familial early-onset of dystonic-guttural tics: An unusual diagnosis of PANDAS. In: J Pediatr Neurosci. 9 (1), Jan 2014, pp. 79-81. doi: 10.4103 / 1817-1745.131497 .
  34. ↑ GA Bernstein, AM Victor, AJ Pipal, KA Williams: Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood obsessive-compulsive disorder. In: J Child Adolesc Psychopharmacol. 20 (4), Aug 2010, pp. 333-340. doi: 10.1089 / cap.2010.0034 .
  35. ↑ D. Martino et al: The role of immune mechanisms in Tourette syndrome. In: Brain Research. 2014. doi: 10.1016 / j.brainres.2014.04.027 .
  36. ↑ Thomas Insel: Microbes and Mental Illness. NIMH website. Published August 13, 2010. nimh.nih.gov.Retrieved August 17, 2013.
  37. ↑ Sagnik Bhattacharyya, Sumant Khanna, Rita Christopher and others: Anti-Brain Autoantibodies and Altered Excitatory Neurotransmitters in Obsessive-Compulsive Disorder . In: Neuropsychopharmacology . 2009, pp. 2489-2496.
  38. ↑ N. Konuk, IO Tekın, U. Ozturk et al: Plasma Levels of Tumor Necrosis Factor-Alpha and Interleukin-6 in Obsessive Compulsive Disorder. In: Mediators of Inflammation. Volume 2007, Article ID 65704.
  39. ↑ PANDAS: A Possible Model for the Pathogenesis of Adult Obsessive Compulsive Disorder. Dipartimento di Scienze Psichiatiche e Medicina Psicologica, Sapienza Università di Roma Riv Psichiatr. 2009. Source Retrieved August 17, 2013.
  40. ↑ D. Marconi, L. Limpido, I. Bersani et al .: PANDAS: a possible model for adult OCD pathogenesis. In: Riv Psichiatr. 44 (5), Sep-Oct 2009, pp. 285-298.
  41. ^ National Institute of Mental Health: Information about PANDAS nimh.nih.gov - Retrieved June 7, 2014.
  42. ↑ Souhel Najjar, Daniel M Pearlman, Kenneth Alper and others: Neuroinflammation and psychiatric illness. In: Journal of Neuroinflammation. 10, 2013, p. 43. doi: 10.1186 / 1742-2094-10-43 .
  43. ↑ Susan E. Swedo, James F. Leckman, Noel R. Rose: From Research Subgroup to Clinical Syndrome. Modifying the PANDAS Criteria to define PANS. pandasnetwork.org ( Memento of the original dated December 8, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 1.0 MB) @1@ 2Template: Webachiv / IABot / pandasnetwork.org
  44. ↑ H. Rhee, DJ Cameron: Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. In: Int J Gen Med. 5, 2012, pp. 163-174. doi: 10.2147 / IJGM.S24212 . PMID 22393303 . Epub 2012 Feb 22.
  45. ↑ Hanna Rhee, Daniel J Cameron: Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. In: International Journal of General Medicine. 2012.
  46. ↑ T. Insel: From Paresis to PANDAS and PANS . ( Memento of the original from May 2, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Director's Posts about Obsessive-Compulsive Disorder (OCD), National Institute of Mental Health , 03/2012; Website accessed May 20, 2012. @1@ 2Template: Webachiv / IABot / www.nimh.nih.gov
  47. ↑ N. Müller et al: Mycoplasma pneumoniae infection and Tourette's syndrome. In: Psychiatry Res. 129 (2), Dec 15, 2004, pp. 119-125. PMID 15590039
  48. ↑ TE Ercan et al.: Mycoplasma pneumoniae infection and obsessive-compulsive disease: a case report. In: J Child Neurol. 23 (3), Mar 2008, pp. 338-340, Epub 2007 Dec 13. PMID 18079308
  49. ↑ Hanna Rhee, Daniel J Cameron: Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. In: International Journal of General Medicine. 2012.
  50. ↑ Katherine E. Muir et al .: A Case Report of Obsessive-Compulsive Disorder Following Acute Disseminated Encephalomyelitis. In: Pediatrics. 132, 2013, p. E771, doi: 10.1542 / peds.2012-2876 .
  51. ↑ J. Asher: Possible causes of sudden onset OCD in kids broadened . In: NIH News. National Institute of Mental Health , 03/2012; Website accessed May 20, 2012.
  52. ^ RK Schneider et al .: Psychiatric presentations of non-HIV infectious diseases. Neurocysticercosis, Lyme disease, and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection. In: Psychiatr Clin North Am. 25 (1), Mar 2002, pp. 1-16. PMID 11912935
  53. ^ Germana Moretti, Massimo Pasquini, Gabriele Mandarelli and others: What every psychiatrist should know about PANDAS: a review. In: Clinical Practice and Epidemiology in Mental Health. 4, 2008, p. 13.
  54. ↑ Finn E. Somnier: Autoimmune encephalitis. Dopamine (post-streptococcal) related autoimmune encephalitis. Department of Clinical Biochemistry, Immunology and Genetics, Staten's Serum Institute, Copenhagen, Denmark, 2013. pandasnetwork.org ( Memento of the original from September 4, 2014 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved June 23, 2014. @1@ 2Template: Webachiv / IABot / pandasnetwork.org
  55. ^ HS Singer, DS Wolf, R. Kurlan: Moving from PANDAS to CANS. In: The Journal of Pediatrics . May 2012, pp. 725-731.
  56. ↑ SE Swedo, J. Seidlitz, M. Kovacevic, ME Latimer, R. Hommer, L. Lougee, Grant P: Clinical Presentation of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections in Research and Community Settings. In: J Child Adolesc Psychopharmacol. 25 (1), Feb 2015, pp. 26-30. doi: 10.1089 / cap.2014.0073 .
  57. ^ Jeff Szymanski: Can an infection suddenly cause OCD? Harvard University (Harvard Medical School) Retrieved June 7, 2014.
  58. ↑ B. Maini, M. Bathla, GS Dhanjal et al .: Pediatric autoimmune neuropsychiatric disorders after streptococcus infection. In: Indian J Psychiatry. 54 (4), Oct 2012, pp. 375-377.
  59. ↑ SE Swedo, HL Leonard, JL Rapoport: The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal infection (PANDAS) Subgroup: Separating Fact From Fiction. In: Pediatrics. Vol. 113, April 2004, pp. 907-911.
  60. ↑ TK Murphy, PD Patel, JF McGuire et al .: Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype. In: J Child Adolesc Psychopharmacol. 25 (1), Feb 2015, pp. 14-25.
  61. ↑ Andrew Mitelman: Treatment & Further Research into PANDAS / PANS. In: What is PANDAS. Massachusetts General Hospital OCD and Rilated Disorders Program, 2012.
  62. ↑ TK Murphy, EA Storch, AB Lewin, PJ Edge, WK Goodman: Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. In: J Pediatr. 160 (2), Feb 2012, pp. 314-319.
  63. ↑ Susan E. Swedo, Jennifer Frankovich, Tanya K. Murphy: Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2017.0042 .
  64. ↑ PANS Diagnostic Criteria, Chapters 1 to 4, PANS / PANDAS Physicians Network (as of July 2017). Retrieved July 19, 2017
  65. ↑ a b Esther Entin: Pediatric Acute Onset Neuropsychiatric Syndrome, PANS . 2012
  66. ^ OCD Foundation.Retrieved June 7, 2014.
  67. ^ Stanford University healthier.stanfordchildrens.org - Retrieved June 7, 2014.
  68. ↑ TK Murphy, PD Patel, JF McGuire et al .: Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype. In: J Child Adolesc Psychopharmacol. 25 (1), Feb 2015, pp. 14-25. doi: 10.1089 / cap.2014.0062
  69. ↑ Susan E. Swedo, James F. Leckman, Noel R. Rose: From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS . ( Memento of the original from December 8, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 1.0 MB) 2012, p. 3. @1@ 2Template: Webachiv / IABot / pandasnetwork.org
  70. ↑ PANS Diagnostic Criteria, Chapters 1 to 4 , PANS / PANDAS Physicians Network (as of July 2017). Retrieved July 19, 2017
  71. ↑ Michael Jenike: Sudden and Severe Onset OCD (PANS / PANDAS) - Practical Advice for Practitioners and Parents
  72. ↑ Finn E. Somnier: Autoimmune encephalitis - History & current knowledge. Department of Clinical Biochemistry, Immunology and Genetics, Staten's Serum Institute, Copenhagen, Denmark. June 24, 2013, p. 31ff. pandasnetwork.org ( Memento of the original from March 19, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 3.1 MB) Source, accessed on August 19, 2013. @1@ 2Template: Webachiv / IABot / pandasnetwork.org
  73. ↑ PANS Diagnostic Guidelines: Somatic Signs and Symptoms including sleep disturbances, enuresis, or urinary frequency. PANDAS Physicians Network. pandasppn.org Retrieved March 6, 2015.
  74. ^ Adam B. Lewin, Eric A. Storch, P. Jane Mutch, Tanya K. Murphy: Neurocognitive Functioning in Youth With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcus. In: The Journal of Neuropsychiatry and Clinical Neurosciences. 23, 2011, pp. 391-398.
  75. ^ Overview of the special edition of the Journal of Child and Adolescent Psychopharmacology. Retrieved July 20, 2017
  76. ^ Margo Thienemann, Tanya Murphy u. a .: Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I - Psychiatric and Behavioral Interventions. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2016.0145 .
  77. ↑ Jennifer Frankovich, Susan Swedo et al. a .: Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II — Use of Immunomodulatory Therapies. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2016.0148 .
  78. ↑ Michael S. Cooperstock, Susan E. Swedo et al. a .: Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III — Treatment and Prevention of Infections. In: Journal of Child and Adolescent Psychopharmacology. 2017, doi: 10.1089 / cap.2016.0151 .
  79. ↑ intramural.nimh.nih.gov
  80. ↑ intramural.nimh.nih.gov (PDF; 94 kB)
  81. ↑ Susan J Perlmutter, Susan F Leitman, Marjorie A Garvey: Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood . (PDF; 103 kB)
  82. ↑ news-medical.net
  83. ↑ intramural.nimh.nih.gov (PDF; 137 kB)
  84. ↑ a b Antibiotic Treatment Trial for the PANDAS / PANS Phenotype (AZT). Retrieved April 13, 2013 .
  85. ↑ Danielle Ung, Chelsea M Ale, Eric A Storch: Optimal management of pediatric obsessive-compulsive disorder. In: Pediatric Health, Medicine and Therapeutics. 3, 2012, pp. 9-18.
  86. ↑ Susanne Walitza, Siebke Melfsen, Thomas Jans and others: Obsessive- compulsive disorder in childhood and adolescence. Review article. In: Deutsches Ärzteblatt. Vol. 108, issue 11, March 18, 2011, p. 176.
  87. ↑ Lisa A Snider, Lorraine Lougee, Marcia Slattery, Paul Grant, Susan Swedo: Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neuropsychiatric Disorders. In: Biol Psychiatry. 57, 2005, pp. 788-792.
  88. ↑ Demian Obregon, Ellisa Carla Parker-Athill, Jun Tan, Tanya Murphy: Psychotropic effects of antimicrobials and immune modulation by psychotropics: implications for neuroimmune disorders. In: Neuropsychiatry (London). 2 (4), August 2012, pp. 331–343. doi: 10.2217 / npy.12.41 .
  89. ↑ M. Murphy, M. Pichichero: Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS). In: Arch Pediatr Adolesc Med. 156, 2002, pp. 356-361.
  90. ↑ Lisa A. Snider, Lorraine Lougee, Marcia Slattery et al: Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neuropsychiatric Disorders . (PDF; 97 kB). In: Biol Psychiatry. 57, 2005, pp. 788-792.
  91. ^ Jeff Szymanski: Can an infection suddenly cause OCD? Harvard Health Blog, Feb 2012.
  92. ↑ Veit Roessner, Kerstin J. Plessen, Aribert Rothenberger et al .: European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. In: Eur Child Adolesc Psychiatry. 20 (4), April 2011, pp. 173-196, doi: 10.1007 / s00787-011-0163-7 .
  93. ↑ Guidelines for Obsessive Compulsive Disorder . ( Memento from October 15, 2014 in the Internet Archive ) (PDF; 568 kB) awmf.org
  94. ↑ German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology: S3 Guideline for Obsessive Compulsive Disorders (AWMF register number 038/017), May 2013.
  95. ↑ Dt. Ges. F. Child and adolescent psychiatry and psychotherapy et al. (Ed.): Guidelines for the diagnosis and therapy of mental disorders in infants, children and adolescents. 3rd, revised edition. Deutscher Ärzte Verlag, 2007.