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What are PANDAS and PANS?

PANDAS and PANS are two names for a mental health syndrome that is often linked to a bacterial infection.  The primary symptom is acute-onset OCD (obsessive-compulsive disorder). Normally, kids with OCD develop the disorder slowly. But in acute-onset OCD, severe symptoms show up suddenly. 

Children with PANS and PANDAS also develop other distressing and confusing symptoms that include regression, tics, eating restriction, rage, depression and even suicidality. These symptoms can show up in children as young as three or four. 

Most cases of PANS and PANDAS are linked to a bacterial infection, usually strep, but some are linked to other infections including Lyme disease, mononucleosis, walking pneumonia and the flu. 

PANS and PANDAS are episodic disorders, which means they come and go. Symptoms may disappear for extended periods then reappear, triggered by a later exposure to strep or some other bacteria or virus. Symptoms may get increasingly severe with multiple recurrences. 

What is the difference between PANS and PANDAS?

After years of controversy over the cause of this syndrome, experts finally agreed on two categories. PANS stands for pediatric acute-onset neuropsychiatric syndrome. It is a name for the syndrome no matter what its cause.  

If the onset of these symptoms is linked to a strep infection, it’s called PANDAS. PANDAS stands for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. It is a subgroup of PANS. About 86 percent of acute-onset OCD cases are linked to strep. 

PANDAS and PANS are more common in boys than girls and usually show up in younger children. 

What are the symptoms of PANDAS and PANS?

Signs that a child might have acute-onset OCD include: 

  • OCD symptoms that show up suddenly 
  • Handwriting becomes unrecognizable 
  • Drawings look like scribbles 
  • Trouble eating 
  • Wetting the bed 
  • Difficulty managing math or reading that used to be easy 
  • Irritability 
  • Extreme and unpredictable emotions 
  • Panic attacks 

Unlike regular OCD, symptoms of PANDAS and PANS start all at once. Parents often say that the child changes “overnight” or “out of the blue.” 

What is the treatment for PANDAS and PANS?

The treatment for acute-onset OCD depends on what the child’s doctor believes caused the disorder. Some doctors think it is best to treat PANDAS and PANS with antibiotics. The idea is that getting rid of any underlying infection will stop the OCD symptoms. 

Doctors who do not think acute-onset OCD is caused by infection usually recommend the same treatments that are used for regular OCD. This can include exposure therapy and antidepressant medication. 

This guide was last reviewed or updated on December 18, 2023.