From obsessions, compulsions, and tics, to personality changes and oppositional behavior, the symptoms of PANS are wide-ranging. PANDAS is considered a subset of PANS that is temporally associated with a Group A streptococcal (GAS) infection.

Emotional stress can trigger an inflammatory cascade response and increase blood levels of proinflammatory cytokines—including IL-1, IL-6, and tumor necrosis factor (TNF-α). These same inflammatory markers intensify in acute episodes of depression and mania.

The debate about whether antidepressants work in children has been with us since the tricyclic era. A recent study evaluated the short-term efficacy and safety of a newer agent, desvenlafaxine (Pristiq).

Historically, psychiatrists did not focus on identifying and treating risk factors for child and adolescent suicidal behavior. But after an increase in youth suicide rates in the 1980s, we started doing more research to get clarity about the issues. For example, we became aware that there were clusters of youth committing suicide—doing so in the same community and during the same time period. We suddenly recognized that hearing about a peer committing suicide would raise the risk for that peer’s close friends.

Clinicians used to say, “Oh, autism is very clear. It’s the one true disorder in child psychiatry.” Now we realize that there’s a spectrum, which makes some sense, especially from a broad evolutionary perspective: If these changes were totally maladaptive, they presumably would have been lost over time; instead, they’ve persisted. That suggests that, for some people, some other combinations of these genes must be somewhat or even quite adaptive.

James Lock, PhD, discusses his experiences treating children and adolescents with eating disorders. In the child psychiatry inpatient unit, among the kids with eating disorders, he saw that half or more were medically ill as a result of malnutrition or other behavioral problems that led to problems with electrolytes or blood pressures. His experiences eventually led him to treatment methods that involved families in an outpatient setting.