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If you see a patient with a sudden and dramatic onset of unwanted thoughts, fears, rituals, obsessive compulsive disorder, and an overall abrupt decline in mental health, consider PANDAS and PANS. Strep or another infection may be triggering the symptoms and distress.

What are the symptoms of PANS/PANDAS?

People with PANS/PANDAS have an abrupt and dramatic onset of OCD or Restrictive Eating Disorder plus additional symptoms from at least 2 of the following categories:

  • Anxiety and/or separation anxiety
  • Emotional lability and/or depression
  • Irritability, aggression, and/or severe oppositional behaviors
  • Behavioral regression
  • Deterioration in school performance
  • Sensory or motor abnormalities (including tics)
  • Somatic signs and symptoms, including sleep disturbances or urinary frequency

What is the difference between PANDAS/PANS and traditional OCD?

PANDAS/PANS may be considered a form of Basal Ganglia Autoimmune Encephalitis. View the comparison chart to learn how PANDAS/PANS varies from traditional childhood OCD.

PANS/PANDAS compared to OCD


PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, concomitant with acute behavioral deterioration in at least two comorbid symptoms from defined categories. While the criteria for diagnosing PANS do not specify a trigger, the syndrome is thought to be an immune reaction to one of a number of physiological stressors including Group A Streptococcal infection, Mycoplasma pneumonia infection, influenza, upper respiratory infections, sinusitis, and psychosocial stresses. PANS has no age limitation.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a subset of PANS. PANDAS has five distinct criteria for diagnosis, including abrupt OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (average of 6–7 years); presence of neurologic abnormalities; and temporal association between symptom onset and Group A strep infection. The 5 criteria usually are accompanied by similar comorbid symptoms as found in PANS.

The Hierarchy of PANS:

What causes PANDAS PANS?


Familiarize yourself with the PANS/PANDAS flowcharts.
The flowcharts for diagnosing and treating PANS and PANDAS walk you through evaluating patients for possible PANS/PANDAS then guides you through treatment considerations based on symptom severity.

Review Seeing Your First Child with PANDAS/PANS.
“Seeing Your First Child with PANDAS/PANS” is a medical guide consisting of: overview and current theories, PANDAS/PANS symptoms and diagnostic criteria, workup recommendations, and expectations.

Read the PANS Research Consortium consensus statement and treatment recommendations.
“In cohorts of well-characterized PANS patients, evidence of postinfectious autoimmunity and/or neuroinflammation is found in more than 80% of cases (Swedo, et al.).” The JCAP papers include details on PANS/PANDAS treatment options including antibiotics to remove the source of inflammation (streptococcus or another infection), anti-inflammatories, IVIG, behavioral therapies, and more.

Access the PPN Practitioner Directory.
Primary care providers, including pediatricians, family physicians, and nurse practitioners, can diagnose PANS/PANDAS and implement the majority of treatments. However, if you need help finding a doctor or medical professional familiar with PANS/PANDAS, visit the PPN Practitioner Directory. Practitioners can request to be listed in the directory by becoming a member of the PPN.

Support PANS/PANDAS Education:
A Mental Health Awareness Month Action

Many clinicians are not aware of the current guidelines for diagnosing and treating these PANS/PANDAS. Investing in education efforts will allow PPN to provide physicians and medical professionals the resources they need to diagnose PANS/PANDAS in the early stages of the illness and promptly begin treatment. Thank you for your support.