Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity

J Psychiatr Res. 2019 Mar;110:93-102. doi: 10.1016/j.jpsychires.2018.11.013. Epub 2018 Nov 14.


Objective: In the clinical syndrome Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), obsessive compulsive disorder (OCD) and/or food refusal symptoms have an abrupt-onset (over 48 h) coupled with at least two other specified neuropsychiatric symptoms. We aimed to characterize in detail for the first time, psychotic symptoms experienced by children with PANS as well as the impact of psychotic symptoms on disease severity and course of illness. We inform about the diagnosis of the clinical description: PANS and hope to improve evaluation, treatment, diagnostic validity and future investigation.

Methods: Retrospective review of 143 consecutive PANS clinic patient charts meeting inclusion criteria. The Caregiver Burden Inventory, Global Impairment Score, and Children's Global Assessment Scale were used to assess impairment.

Results: Visual and auditory hallucinations were each experienced by 36%, of which most (83%) were transient and complex (non-threatening voices or figures). 6.3% and 5.5% of patients experienced delusions and thought disorganization respectively. Those with psychotic symptoms showed statistically significant differences in disease impairment and caregiver burden. There were no differences in time to treatment access or length of illness.

Conclusions: Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.

Keywords: Basal ganglia; Hallucinations; Neuropsychiatric; Pediatric acute-onset neuropsychiatric syndrome (PANS); Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS); Psychosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autoimmune Diseases / complications
  • Autoimmune Diseases / physiopathology*
  • Child
  • Child, Preschool
  • Cognition Disorders / etiology
  • Cognition Disorders / physiopathology*
  • Delusions / etiology
  • Delusions / physiopathology*
  • Female
  • Hallucinations / etiology
  • Hallucinations / physiopathology*
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / complications
  • Obsessive-Compulsive Disorder / physiopathology*
  • Psychotic Disorders / etiology
  • Psychotic Disorders / physiopathology*
  • Retrospective Studies
  • Severity of Illness Index
  • Streptococcal Infections / complications
  • Streptococcal Infections / physiopathology*

Supplementary concepts

  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
  • Pediatric acute-onset neuropsychiatric syndrome