Psychosocial Adjustment

Due to the sudden onset of this illness as well as the significant psychiatric symptoms, many children rapidly go from having "normal" functioning to having severe impairments. Murphy and Pichichero (2002) followed 12 children for 3 years after their initial PANDAS episode; during the initial episode, 4 out of the 12 children were referred for psychiatric evaluation due to the severity of their symptoms. For 3 of these 4 children, the psychiatric symptoms were so intense that they became incapacitated and unable to leave their home (Murphy and Pichichero 2002). The children themselves found the psychiatric symptoms quite upsetting. This is thought to be due to the fact that there was a clear distinction between pre-and postillness functioning (Swedo et al. 1998).

PANDAS is associated with many comorbid psychiatric conditions. ADHD, affective disorders, and anxiety disorders were the most common comorbid psychiatric diagnoses associated with the 50 initial PANDAS patients. Swedo et al. (1998) also delineated the behavioral symptoms associated with exacerbation of PANDAS in the first 50 cases and found that the most common difficulties were emotional lability (66%), changes in school performance (60%), personality change (54%), bedtime fears/rituals (50%), fidgetiness (50%), separation anxiety (46%), irritability (40%), tactile/sensory de-fensiveness (40%), and impulsivity/distractibility (38%). These comorbid behavioral symptoms always occurred at the same time that the OCD and tics began or worsened and were associated with an increase in antistreptoccal antibody titers (Swedo et al. 1998). Antibiotic treatments that reduced the severity of OCD and tic behaviors also dramatically reduced these comorbid psychiatric conditions (Swedo et al. 1998).

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