New finding in the PANDAS/PANS spectrum.
This is a report of three interesting patients with post-infectious, Obsessive, Compulsive Disorder (OCD), anxiety, and depression. Curious diagnostic findings and a novel and new effective treatment implemented.
PANDAS/PANS is not a single distinct entity. Indeed, it is a post infectious neuropsychiatric syndrome with a myriad of presentations. There is not a single diagnostic test for every patient with symptoms and problems of a post infectious problem. This lack of a single entity with a single symptom cluster, and a single metabolic profile is a source of great annoyance to those in a profession who require absolutism and who abhor the need to stop and think about the complexities of this syndrome.
In the past three months, I and a colleague have encountered three cases of individuals with severe OCD coupled with anxiety, panic, and various degrees of depression. Two of the individuals could recall that their symptoms occurred directly after a significant infection. One was severe colitis another a strep infection. All had been treated with a panoply of SSRI’s and atypicals. None had been treated with Anafranil or other tricyclics or a benzodiazepine. Nor had they been evaluated for PANDAS.
At my direction all three patients had a comprehensive metabolic survey for evidence of acute or chronic infection, as well as the status of their immune systems. All three patients showed evidence of acute inflamation. In all three cases, the immunologic survey showed inconsistent results. In all three cases, there were significant abnormalities of the Pneumococcal. Subtypes, 23 valent. The precise significance of these markers have not been established. Nonetheless, each patient received a standard dose of Pneumovax 23.
Within 36 hours each patient, showed dramatic improvement. The patients were told ahead of time that the vaccine could affect their OCD and other symptoms. They were advised that there was a deficiency in their pneumonia antibodies and vaccination was advised. All accepted that.
Patients and family members were amazed that patient's circumstances had turned around. There was dramatic improvement in physical and emotional manifestations of their problems. Obsessions and compulsions diminished by greater than 90% in each case. Anxiety diminished similarly. The one patient with profound depression for several years suddenly was able to smile, laugh and enjoy life.
This data is important in many ways. It suggests that true medical/metabolic evaluation of psychiatric patients who have many different complaints is actually a proper baseline for care and treatment. It suggests that while there is no one thing that can be called PANDAS/PANS it is, nonetheless a reality.
Naysayers may say that this information is meaningless, not from a controlled study nor by sycophants from various “experts” at centers of supposed self-proclaimed excellence. It is old-fashioned, clinical empiricism that happens when the doctors actually examine the patients, diagnose and treat them, without external rules about what they can and cannot think, say, or do.
This information is presented as it is, and without the review of those who have no idea and/or no belief in what we write about.
Jory F Goodman, MD
