PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci

I recently became aware of this condition where a variety of emotional and psychiatric symptoms arise due to an adverse reaction to the strep virus. I hope to raise awareness and note the import of understanding this condition for mental health professionals and consumers.
Years ago, I specialized in child mental health and saw cases of anxiety with no apparent precursor. Despite my psychodynamic training, it became clear to me that family dynamics played little to no role in the etiology of these conditions. However, in some of the cases, I could find no clear explanation. I suspect I was dealing with PANDAS. Some background:

PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette’s Syndrome, and in whom symptoms worsen following streptococcus infections such as “Strep throat” and Scarlet Fever.
The children usually have dramatic, “overnight” onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is generally preceeded by a Strep throat infection.

How does Strep throat lead to PANDAS?

What is the mechanism behind this phenomenon? At present, it is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and “attack” the heart valves, joints, and/or certain parts of the brain. This phenomenon is called “molecular mimicry”, which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham鈥檚 Chorea or St. Vitus Dance.
In PANDAS, it is believed that something very similar to Sydenham鈥檚 Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.

In other cases, the child with PANDAS can become fearful, especially surrounding separations from parents. Mood swings have an abrupt onset and are more extreme than prior to the strep infection. There is a clear and dramatic change.
The best treatment seems to be antibiotics to address the strep infectiom. However, even after the infection is ended, the antibodies can remain in the child with negative impact.
I suspect many counselors have seen children with PANDAS without knowing it. The following description seems quite plausible:

Typically, a child with undiagnosed PANDAS may be taken to the Psychologist and/or Paediatrician for treatment of an onset or exacerbation of ADHD symptoms, oppositional behaviours or OCD. Stimulant or anti-depressant medication may be prescribed and/or a behavioural intervention or counselling initiated. As the infection passes and the strep antibodies reduce, the symptoms gradually subside and parents and clinicians believe that the intervention was successful. However then there is another strep infection, the symptoms return and the process is repeated. The problem is that the brain is being continuously damaged by the repeated attacks by streptococcus antibodies; and after each attack the recovery of damaged brain tissues may not be as complete as we would hope. Eventually the child may develop a chronic psychiatric disorder

This condition should cause health professionals to reconsider models of personality and psychopathology development. Counselors advising parents who have a child with PANDAS might be tempted to propose environmental theories for sudden anxiety states. However, such hypotheses would be far off. Counselors should take detailed health histories even with adult clients given how this biological causal factor gradually coould compromise mental health and lead to a psychiatric condition. Rather than hunt for psychic trauma, a bacterial trauma may be implicated.
This disorder came up on another thread regarding causes of same-sex attraction. There is no evidence as yet that a virus/bacteria could create a similar autoimmune reaction which would effect brain development or perhaps glutamate levels in the developing brain. However, it appears that behavior and emotional experience are effected in PANDAS. Is it a stretch to think other experiences (e.g., sexual attraction) might be altered in some similar manner?
Part 2 discusses a paradigm shift in treatment stimulated by PANDAS.