Treatment Guidelines

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Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome. From the Special Issue: PANS-PANDAS Treatment Guidelines
Journal of Child and Adolescent Psychopharmacology. VOLUME 27, ISSUE 7 / SEPTEMBER 2017

Click the links below for Treatment Guidelines in the format of peer-reviewed journal articles.

Overview

Methods and Use of Guidelines

Part I

Psychiatric and Behavioral Interventions

Part II

Use of Immunomodulatory Therapies

Part III

Treatment and Prevention of Infections

Guidelines for Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome

Members of the PANS Research Consortium (first convened 2013) formed workgroups to clarify diagnostic boundaries, identify research needs and develop treatment guidelines to be reviewed. Preliminary findings were published in 2017 with the intent to continue evolving our understanding of diagnosis and treatment of PANS.

Treatment of PANS depends on three complementary modes of intervention:
1. Treating the symptoms with psychoactive medications, psychotherapies (particularly cognitive behavioral therapy), and supportive interventions.
2. Removing the source of the inflammation with antimicrobial interventions.
3. Treating disturbances of the immune system with immunomodulatory and/or anti-inflammatory therapies.

My opinion

We need more reasearch! I hope for better understanding of PANS leading to protocols for psychological/behavioural interventions to guide psychologists, OTs and other allied health. I anticipate the need for a stepped approach to behavioural intervention like that seen for medical intervention, so that we appropriately respond to fluctuating needs at different levels of exacerbation during flares. I am seeing barriers to engagement in CBT from problems with inattention, memory lapses, poor insight/delusional thinking, chronically dysregulated states and PDA (demand avoidance which can be mistaken for ODD/oppositional behaviours). In flare exacerbations, children require accommodations and medical intervention. Once inflammation recedes and children have increasing capacity to attend, learn and regulate, remediation becomes increasingly relevant.

See My Treatment Approach Here.

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