PANS and PANDAS--a hitherto normal child suddenly develops severe OCD symptoms. These may include refusing to leave the house, engaging in constant checking and washing rituals, asking repeatedly if the door is locked, making odd facial movements, having full-on tantrums with kicking and screaming, wetting the bed, and being unable to perform in school. “I lost my child overnight” was, and is, a common refrain.

How do you confidently diagnose a child that you suspect is presenting with PANDAS/PANS? (See lead article for definition.) And if you do make that diagnosis, how should treatment proceed? Child psychiatrist Erica Greenberg sees new cases almost every week. We turned to her for some boots-on-the-ground guidance.

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Tourette’s disorder (TD), also known as Tourette syndrome, is a fascinating yet complex neurodevelopmental disorder that can be challenging to treat. Dr. Georges Gilles de la Tourette, a French neurologist who described the first nine cases in 1885, had it right when he described the “peculiar” symptoms as a syndrome, later reporting that “fears, phobias, and arithmomania” were part of the picture.

Dr. Greenberg works in the obsessive compulsive disorder (OCD) and related disorders program, and I see both kids with tics and OCD or OCD-related disorders as well as those with symptoms consistent with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) or pediatric acute-onset neuropsychiatric syndrome (PANS). She typically sees two to three new patients a week who fit somewhere in the OCD, tic, or PANDAS spectrum.

Study Reviewed: Lenhard F et al. Therapist-guided, Internet-delivered cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2017;56(1):10–19. doi:10.1016/j.jaac.2016.09.515

The pharmacological treatment of obsessive-compulsive disorder (OCD) for adults is pretty well worked out. Selective serotonin reuptake inhibitors (SSRIs) are the gold-standard treatment. We have multiple randomized, placebo-controlled trials to back this up. However, we know less about medication treatment of OCD for children.

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Skin picking disorder is a compulsive behavior affecting 5% of people. N-acetylcysteine is an antioxidant that increases glutamate, and studies have shown that it is effective for excoriation’s sister disorder, trichotillomania (hair pulling). These data prompted investigators to try N-acetylcysteine in the treatment of SPD.

Get some practical advice on how child psychiatrists can use therapy to help kids with anxiety disorders, in an interview with Robin Zasio, PsyD, LCSW, owner and director of The Anxiety Treatment Center in Sacramento, CA.