A primary school-going boy, usually cheerful and full of energy, suddenly became consumed by a fear of germs. His hands, dry and rough due to excessive washing, showcases the marks of an obsession that has seemingly surfaced overnight. His parents were perplexed. What could have triggered such drastic changes in their child? After extensive medical consultations, the answer came unexpectedly; a simple strep throat infection had taken a brutal turn, leading to the diagnosis of PANDAS Syndrome.
This scenario isn’t as uncommon as it seems; PANDAS, or Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection is a condition that manifests in children following a streptococcal infection, such as strep throat or scarlet fever. In a conversation with the OnlyMyHealth team, Dr Rajiv Mehta, Vice-Chairperson, Psychiatry, Sir Ganga Ram Hospital, New Delhi, explains, “PANDAS primarily affects children under the age of 13, though it can occasionally occur in teenagers up to 18 years old.”
RELATED: Children’s Health: Can Common Infections Trigger Mental Health Illnesses In Kids?
What Is PANDAS Syndrome?
PANDAS is characterised by a sudden onset of obsessive-compulsive disorder (OCD) or tics after a strep infection. These symptoms often appear overnight, catching parents off guard. Alongside OCD behaviours, children may display motor or vocal tics, mood swings, separation anxiety, and even psychotic symptoms. Dr Mehta elaborates, “The symptoms are dramatic and acute, ranging from obsessive-compulsive tendencies to aggression and anxiety attacks.”
How Can Parents Spot Signs Of PANDAS Syndrome?
Dr Mehta says, “PANDAS occurs after a streptococcal infection and manifests as neurological and psychiatric symptoms. The most common symptom of pandas is obsessive compulsive disorder. The other manifestations can be acute onset of mood and anxiety symptoms, tics like movements, acute onset of aggression or psychotic symptoms and the symptoms are generally acute in onset.”
An elaborated lowdown of the psychological symptoms is as follows,
- Depression or anxiety.
- Bed-wetting
- Personality or emotional shifts, including abrupt anger or irritation.
- Trouble falling asleep.
- Indifference to food.
- Restlessness and signs resembling those of attention-deficit/hyperactivity disorder (ADHD).
- OCD Behaviours
- Separation Anxiety
- Occurence of tics similar to Tourette's syndrome.
Physical symptoms that manifest alongside OCD can range from tics, sensitivity to light and sound, and poor motor skills to more severe issues like joint pain, bedwetting, or even a near-catatonic state.
How Does PANDAS Syndrome Develop?
The syndrome is believed to occur when the immune system, in its attempt to fight off the streptococcal bacteria, mistakenly attacks healthy brain cells. This misdirected response leads to neurological and psychiatric symptoms. Dr Mehta notes, “Antibodies produced during the infection may target brain tissues, causing the symptoms commonly associated with PANDAS.”
How Is PANDAS Diagnosed And Treated?
Diagnosing PANDAS can be challenging, as its symptoms overlap with other disorders like OCD and Tourette syndrome. However, a detailed medical history, particularly recent strep infections, can provide vital clues. According to Dr Mehta, “If a history of upper respiratory tract infection is present, tests such as ASLO (Antistreptolysin O) titers are conducted to confirm a streptococcal infection. Treatment then includes antibiotics as well as symptomatic treatments to address the infection and medications for neuropsychiatric symptoms.”
While antibiotics can eliminate the infection, the behavioural symptoms may persist and require prolonged treatment as per our expert; including therapy and, in some cases, medication to manage severe anxiety or OCD.
RELATED: Confused Between Sore Throat And Strep Throat? Know Difference From An Expert
Tips Parents Can Follow To Support Their Child During This Gruelling Period
For parents, managing a child with PANDAS can be daunting. Understanding and responding to symptoms with care and calmness is essential. Here are some practical strategies:
- Maintain a calm presence as children with PANDAS aren’t acting out deliberately. Staying calm and composed during outbursts can help de-escalate situations.
- Validate their feelings. Acknowledging your child’s emotions without judgment is crucial. Phrases like, “I can see you’re upset,” show understanding and build trust.
- Create a safe space by designating a quiet, comforting area in your home where your child can retreat during overwhelming moments.
- Use distraction techniques and redirect their focus to enjoyable activities, music, or humour to diffuse tense situations.
- Set clear boundaries and be consistent. Establish clear rules and reinforce them gently but firmly.
- Practice deep breathing together, teach your child breathing exercises during calm moments so they can use them during stressful episodes. This will also make them feel like they’re not alone.
- Seek professional help as frequent or intense symptoms may require the intervention of a child psychologist or psychiatrist for tailored therapy and guidance.
- Monitor triggers by keeping a record of episodes to identify triggers. This can help parents in avoiding or managing future episodes.
Why Does Awareness Matter?
PANDAS often goes undiagnosed or misunderstood due to its complex symptoms. Timely diagnosis and treatment can significantly improve a child’s quality of life, making it essential for parents to recognise the signs and seek appropriate medical care. Dr Mehta emphasises, “Early intervention is critical in preventing long-term complications and helping children regain normalcy.”
By staying informed and proactive, parents can actively help their little ones by supporting them through the challenges of PANDAS, which is quite gruelling and frustrating for children as they too feel lost in an attempt to make sense of what's happening with them.