Beverly Hills Shrink: Adult PANDAS: Bare Facts
The question of PANDAS in adults largely has been ignored with uninformed, erroneous comments and statements that adults cannot acquire PANDAS. Hence, they cannot have it.. This paper will present evidence-based clinical research data to prove that adults can have or acquire PANDAS. A broad range of neuropsychiatric and physical symptoms will be described [see table I]. Many of these have been diagnosed as primary problems and treated ineffectively as such. Others have been misdiagnosed and mistreated. Some simply have been missed [see table II].
A brief discussion of clinical and laboratory diagnostic tools will occur7,9. Comments on the viable treatment options available will be made, again from the perspective of the author's evidence-based clinical research.11,12
Certainly adults can acquire PANDAS. However this would require exposure to a novel infectious agent for that adult. Adult acquisition would, for all intents and purposes, be similar to native Americans and Polynesians falling victim to diseases brought by European explorers. Most commonly adults have had PANDAS for many years but either it has not been considered or it has been misdiagnosed and typically poorly treated as some other neuropsychiatric or physical complaint.
Diagnosis in adults is a logical extension of the diagnosis in children. Thus far the majority of the diagnoses in children are made after the phenomenon has been present for some time. In adults the phenomena have been present for years or decades. Indeed there are an increasing number of reports of acute onset PANDAS in children: Obsessive Compulsive Disorder (OCD); Tourette's and Tics are the most frequent. One familiar with PANDAS immediately considers this diagnosis with acute onset and needs to look for it in patients with other symptomatology [see table III]. In the author's practice innumerable children and adolescents previously diagnosed with Anorexia Nervosa (AN), various anxiety disorders, OCD, Tics and Tourette's, body dysmorphic disorder and quite commonly bipolar disorder (BPD) have been diagnosed with PANDAS, undergone effective treatment and their prior diagnoses disappear. This is of particular importance in BPD, OCD and AN.
The tantrums, outbursts, lability, aggressiveness, ready anger and other symptomatology that leads to the diagnosis of BPD and the treatment thereof in children and adolescents repeatedly has turned out to be PANDAS induced Tourette's, with or without generalized anxiety disorder (GAD) and/or panic disorder (PD). In most of these cases removal of tonsils and adenoids has “cured” the bipolar disorder.11. Patient's have been removed from potent mood stabilizers and atypical antipsychotics as well as [Table II] SSRIs.13 In most cases the patients have Attention Deficit Hyperactivity Disorder (ADHD), usually undiagnosed, which has contributed materially to the overall problems.14 This is an important point which will be elaborated upon further below.
Similarly in adolescent girls with AN,7,15 most of whom have been through months and years of eating disorder treatment, in facilities and hospitals, careful clinical and laboratory examination reveals their true diagnoses to be PANDAS. Most patients with AN have significant symptoms of anxiety and OCD. The OCD symptoms are ego dystonic (OCD is misdiagnosed frequently in patients with ADHD who use obsessive-compulsive mechanisms to bind anxiety–of course this leads to ineffective treatment for the “OCD”). There is an obvious element of body dysmorphic disorder in their preoccupations with weight and image. Again the diagnosis and treatment of the underlying PANDAS which has been driving this constellation of symptoms leads to dramatic resolution of the “eating disorder”, much to the consternation of the devoted eating disorder therapists. And yes, most of these patients have concurrent ADHD.
This experience with dozens of children and adolescents led the author to examine adults with the same group of diagnoses. It is important to remark at this time that most of the children, adolescents and adults had never done particularly well with any therapeutic intervention for their purported diagnoses [Table II]. Nonetheless examination of adult patients with: OCD; BPD; AN; body dysmorphic disorder; fibromyalgia; and all of the other diagnoses noted in Table I led to the diagnosis of PANDAS. And again, as with the children and adolescents, the putative diagnoses dissolved with proper treatment. Treatment of underlying or concurrent diagnoses of depression, anxiety, ADHD, sleep disorders and so forth then became simple and effective. Elevated anti-DNAase B antibodies plummeted. A 64-year-old woman with a long history of depression, anxiety, poor sleep, fibromyalgia and Systemic lupus erythematosus (SLE) who also had obvious ADHD and periodic limb movement disorder (PLMD) experienced a complete disappearance of her fibromyalgia symptoms after tonsillectomy. Aches and pains went away. Energy improved. Sleep became restorative and attention and mood improved with proper treatment. Anti-DNAase B antibody levels dropped. Her ANA, elevated for many years dropped to a normal level.
Over the past 15 years the phenomenon of Pediatric Autoimmune Neurologic and Psychiatric Disorders Associated with Strep, (PANDAS), has been identified around the world1,2. Despite naysayers and nonbelievers the evidence-based clinical data in conjunction with laboratory evidence establishes the existence of this disorder beyond any reasonable doubt.2,3 There remains great confusion as to precisely what neuropsychiatric and/or physical symptoms may be associated with PANDAS4,10; whether or not agents other than Streptococcus cause PANDAS5,6, and what potential laboratory findings may make or support this diagnosis7,8. This leads to further confusion and consternation with respect to diagnostic evaluation, and of greater importance, when, how and what to do to treat the protean manifestations of this disorder.Autoimmune phenomena are responsible for a staggering number of NeuroPsychiatric and Medical problems. With this knowledge the diagnoses, prognoses and lives of hundreds of thousands of patients can be altered and improved in a very short time.
The question of PANDAS in adults largely has been ignored with uninformed, erroneous comments and statements that adults cannot acquire PANDAS. Hence, they cannot have it.. This paper will present evidence-based clinical research data to prove that adults can have or acquire PANDAS. A broad range of neuropsychiatric and physical symptoms will be described [see table I]. Many of these have been diagnosed as primary problems and treated ineffectively as such. Others have been misdiagnosed and mistreated. Some simply have been missed [see table II].
A brief discussion of clinical and laboratory diagnostic tools will occur7,9. Comments on the viable treatment options available will be made, again from the perspective of the author's evidence-based clinical research.11,12
Certainly adults can acquire PANDAS. However this would require exposure to a novel infectious agent for that adult. Adult acquisition would, for all intents and purposes, be similar to native Americans and Polynesians falling victim to diseases brought by European explorers. Most commonly adults have had PANDAS for many years but either it has not been considered or it has been misdiagnosed and typically poorly treated as some other neuropsychiatric or physical complaint.
Diagnosis in adults is a logical extension of the diagnosis in children. Thus far the majority of the diagnoses in children are made after the phenomenon has been present for some time. In adults the phenomena have been present for years or decades. Indeed there are an increasing number of reports of acute onset PANDAS in children: Obsessive Compulsive Disorder (OCD); Tourette's and Tics are the most frequent. One familiar with PANDAS immediately considers this diagnosis with acute onset and needs to look for it in patients with other symptomatology [see table III]. In the author's practice innumerable children and adolescents previously diagnosed with Anorexia Nervosa (AN), various anxiety disorders, OCD, Tics and Tourette's, body dysmorphic disorder and quite commonly bipolar disorder (BPD) have been diagnosed with PANDAS, undergone effective treatment and their prior diagnoses disappear. This is of particular importance in BPD, OCD and AN.
The tantrums, outbursts, lability, aggressiveness, ready anger and other symptomatology that leads to the diagnosis of BPD and the treatment thereof in children and adolescents repeatedly has turned out to be PANDAS induced Tourette's, with or without generalized anxiety disorder (GAD) and/or panic disorder (PD). In most of these cases removal of tonsils and adenoids has “cured” the bipolar disorder.11. Patient's have been removed from potent mood stabilizers and atypical antipsychotics as well as [Table II] SSRIs.13 In most cases the patients have Attention Deficit Hyperactivity Disorder (ADHD), usually undiagnosed, which has contributed materially to the overall problems.14 This is an important point which will be elaborated upon further below.
Similarly in adolescent girls with AN,7,15 most of whom have been through months and years of eating disorder treatment, in facilities and hospitals, careful clinical and laboratory examination reveals their true diagnoses to be PANDAS. Most patients with AN have significant symptoms of anxiety and OCD. The OCD symptoms are ego dystonic (OCD is misdiagnosed frequently in patients with ADHD who use obsessive-compulsive mechanisms to bind anxiety–of course this leads to ineffective treatment for the “OCD”). There is an obvious element of body dysmorphic disorder in their preoccupations with weight and image. Again the diagnosis and treatment of the underlying PANDAS which has been driving this constellation of symptoms leads to dramatic resolution of the “eating disorder”, much to the consternation of the devoted eating disorder therapists. And yes, most of these patients have concurrent ADHD.
This experience with dozens of children and adolescents led the author to examine adults with the same group of diagnoses. It is important to remark at this time that most of the children, adolescents and adults had never done particularly well with any therapeutic intervention for their purported diagnoses [Table II]. Nonetheless examination of adult patients with: OCD; BPD; AN; body dysmorphic disorder; fibromyalgia; and all of the other diagnoses noted in Table I led to the diagnosis of PANDAS. And again, as with the children and adolescents, the putative diagnoses dissolved with proper treatment. Treatment of underlying or concurrent diagnoses of depression, anxiety, ADHD, sleep disorders and so forth then became simple and effective. Elevated anti-DNAase B antibodies plummeted. A 64-year-old woman with a long history of depression, anxiety, poor sleep, fibromyalgia and Systemic lupus erythematosus (SLE) who also had obvious ADHD and periodic limb movement disorder (PLMD) experienced a complete disappearance of her fibromyalgia symptoms after tonsillectomy. Aches and pains went away. Energy improved. Sleep became restorative and attention and mood improved with proper treatment. Anti-DNAase B antibody levels dropped. Her ANA, elevated for many years dropped to a normal level.
