PANS/PANDAS Management

Question 1

What are the 3 complementary models of PANS intervention?

Answer 1

1.Treating the symptoms with psychoactive
medications, psychotherapies (particularly
cognitive behavioural 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

Question 2

What are the preffered meds to treat OCD in PANS

Answer 2

SSRis

Question 3

What is the most effective psychotherapy method to treat OCD in PANS

Answer 3

CBT

Question 4

What meds for incapacitating OCD

Answer 4

low dose of anti-psychotics (Aripiprazole and Risperidone)

Question 5

What to use for severe tics?

Answer 5

HRT, ERP, Clonidine (alpha 2 agonists) and anti-dopaminergics (Aripiprazole)

Question 6

What meds to use for severe irritability and aggression?

Answer 6

anti-histamines, Benzodiazepines, low dose anti-psychotics

Question 7

What meds/intervention to use for sleep problems?

Answer 7

Strict sleep hygiene, behavioural sleep interventions, melatonin, anti-histamines, clonidine, trazodone

Question 8

What meds for distressing psychotic symptoms?

Answer 8

Aripiprazole, Risperidone, Olanzapine, Haloperidol, Quetiapine

Question 9

What is ERP?

Answer 9

1. Exposure: Deliberate exposure to all avoided and anxietyprovoking situations
2. Ritual Prevention: Prevention of any rituals or any strategy
   aimed at neutralising the anxiety

Question 10

Which SSRIs to use in PANS

Answer 10

 Clomipramine
 Fluoxetine
 Fluvoxamine
 Sertraline
 Citalopram
 Escitalopram
 Paroxetine
! the higher the does the bigger the effect

Question 11

What downside effect tends to occur after withdrawl from antipsychotics?

Answer 11

Symptoms tend to relaps when drug discontinued

Question 12

What are other somatic treatments for PANS?

Answer 12

Some centres offer psychosurgery when everything else
has failed
 Cingulotomy
 Capsulotomy
 Approx 40-50 response rate
 No RCTs (one underway in Brazil)
 Highly invasive and controversial

New experimental treatments:
 Transcraneal magnetic stimulation
 Deep Brain Stimulation