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Day: 3 July 2024

Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS) and OCD

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Understanding Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS) and Its Connection with OCD

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections, commonly known as PANDAS, is a term coined to describe a subset of children who experience sudden onset obsessive-compulsive disorder (OCD) and/or tic disorders following a streptococcal infection, such as strep throat or scarlet fever. The concept of PANDAS was first introduced by Dr. Susan Swedo and her colleagues at the National Institute of Mental Health (NIMH) in the late 1990s, who observed a pattern of abrupt, severe neuropsychiatric symptoms in children following streptococcal infections.

The Mechanism Behind PANDAS

PANDAS is believed to be an autoimmune condition, wherein the body’s immune system mistakenly targets the brain. The hypothesized mechanism involves molecular mimicry, where the immune system, while attacking the streptococcal bacteria, also targets brain tissues due to structural similarities. This immune response is thought to interfere with the basal ganglia, a part of the brain involved in movement and behavior regulation, leading to the abrupt onset of OCD and tics.

Symptoms and Diagnosis

Children with PANDAS typically show a dramatic, sudden onset of OCD symptoms, tics, or both, following a streptococcal infection.

The symptoms can include:

  • Severe anxiety and panic attacks
  • Ritualistic behaviors and compulsions
  • Motor and vocal tics
  • Mood swings, irritability, and aggression
  • Changes in handwriting and academic performance
  • Sensory sensitivities
  • Sleep disturbances

Diagnosis of PANDAS is primarily clinical, based on a combination of symptom history and laboratory evidence of a recent streptococcal infection. The criteria for diagnosis include:

  1. Presence of OCD and/or tic disorders.
  2. Pediatric onset of symptoms (typically between 3 years and puberty).
  3. Episodic course of symptom severity.
  4. Association with streptococcal infection.
  5. Association with other neuropsychiatric symptoms such as ADHD, separation anxiety, and mood changes.

PANDAS and OCD: The Connection

Obsessive-Compulsive Disorder (OCD) is a condition characterized by persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). In PANDAS, the onset of OCD symptoms is particularly rapid and severe, distinguishing it from the more gradual development seen in typical childhood OCD.

The connection between PANDAS and OCD underscores the impact of autoimmune processes on neuropsychiatric health. In PANDAS, the immune system’s response to infection not only targets the pathogen but also inadvertently affects brain function, leading to the manifestation of OCD and other neuropsychiatric symptoms.

Treatment Approaches

Treatment for PANDAS involves addressing both the underlying infection and the neuropsychiatric symptoms.

The main approaches include:

  1. Antibiotics: To eradicate the streptococcal infection and prevent further immune response.
  2. Immunomodulatory Therapies: Such as intravenous immunoglobulin (IVIG) or plasmapheresis to reduce autoimmune activity.
  3. Psychiatric Medications: Including selective serotonin reuptake inhibitors (SSRIs) for OCD symptoms and other psychiatric medications for co-occurring symptoms.
  4. Cognitive Behavioral Therapy (CBT): Especially exposure and response prevention (ERP) to manage OCD symptoms.

Controversies and Challenges

The concept of PANDAS has been subject to debate within the medical community. Some experts argue that the evidence linking streptococcal infections to neuropsychiatric symptoms is not conclusive and that the diagnostic criteria are too broad. Moreover, the overlap of PANDAS symptoms with other pediatric neuropsychiatric disorders adds to the complexity of diagnosis and treatment.


PANDAS represents a fascinating intersection between infectious disease and neuropsychiatry, highlighting how an immune response to a common bacterial infection can lead to significant behavioral and psychological changes in children. While the condition remains controversial and more research is needed to fully understand its mechanisms and optimal treatment strategies, the recognition of PANDAS has paved the way for new approaches to diagnosing and managing sudden-onset OCD in children, offering hope for affected families.

Understanding PANDAS and its connection to OCD not only aids in the effective treatment of affected children but also provides a broader insight into the ways in which immune responses can impact mental health. As research progresses, it is hoped that more definitive answers and improved therapeutic options will emerge, further bridging the gap between physical and mental health in pediatric care.

Further Reading

A Guide On How To Recover Payments

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Brown and Cream Image Depicting a Typewriter With The Wording ‘How To Guide’ Typed On Paper. Image Credit Photofunia.com Category Vintage Typewriter.

Disclaimer: This article is aimed at a UK audience, and the information provided herein is based on UK laws and regulations. Please note that different laws and procedures may apply to other geographical locations. Readers are advised to consult legal professionals or relevant authorities in their respective regions for guidance specific to their circumstances.

A Comprehensive Guide on How to Recover Payments as a Disabled Entrepreneur When a Client Breaches the Terms of an Agreement

Running a business as a disabled entrepreneur comes with its unique set of challenges. One of the most frustrating situations is when a client breaches the terms of an agreement and fails to make payments.

However, there are structured steps you can take to recover your dues effectively.

1. Understand the Breach

First, it’s crucial to clearly understand the nature of the breach. Review the contract to pinpoint the exact terms that were violated. Common breaches include late payments, non-payment, or not fulfilling other agreed-upon obligations.

Action Steps:

  • Re-read the contract and note the specific clauses that have been breached.
  • Document all instances of the breach, including missed payment dates, amounts, and any communication with the client.

2. Communicate with the Client

Sometimes, a breach occurs due to misunderstandings or unforeseen circumstances. Initiate a conversation with your client to discuss the issue. This could resolve the problem amicably without further escalation.

Action Steps:

  • Send a formal email or letter detailing the breach and requesting a meeting to discuss the matter.
  • Be professional and factual in your communication, avoiding any accusatory or emotional language.
  • Keep records of all communications for future reference.

3. Send a Formal Demand Letter

If informal communication doesn’t yield results, the next step is to send a formal demand letter. This letter should clearly state the breach, the amount owed, and a deadline for payment before legal action is considered.

Action Steps:

  • Draft a clear and concise demand letter. Include details of the contract, the breach, and the amount owed.
  • Mention the deadline for payment and the consequences of non-compliance (such as legal action).
  • Send the letter via a method that provides proof of delivery, such as registered mail or a courier service.

4. Leverage Mediation or Arbitration

Many contracts include a mediation or arbitration clause for dispute resolution. These methods can be faster and less expensive than going to court and often lead to mutually agreeable solutions.

Action Steps:

  • Review your contract to check for any mediation or arbitration clauses.
  • Contact a professional mediator or arbitrator to initiate the process.
  • Prepare all necessary documentation and evidence to present your case effectively.

5. Engage a Debt Collection Agency

If the client continues to ignore your demands, hiring a debt collection agency might be a practical solution. These agencies specialize in recovering overdue payments and have the resources to pursue the matter persistently.

Action Steps:

  • Research and choose a reputable debt collection agency.
  • Provide the agency with all relevant documentation and information regarding the debt.
  • Understand the fees or percentage of the recovered amount that the agency will charge.

6. Take Legal Action

As a last resort, you may need to take legal action to recover your payment. This step can be time-consuming and expensive, but it might be necessary to get your dues.

Action Steps:

  • Consult with a lawyer who specializes in contract law and has experience with similar cases.
  • File a lawsuit in the appropriate court, providing all necessary documentation and evidence.
  • Be prepared for the legal process, which may involve court appearances and negotiations.

7. Utilize Disability Advocacy Services

As a disabled entrepreneur, you may have access to specific advocacy services that can provide additional support. These organizations can offer legal advice, financial assistance, and other resources tailored to your needs.

Action Steps:

  • Research disability advocacy organizations in your area.
  • Reach out for advice and support related to your situation.
  • Utilize any available resources to strengthen your case and recovery efforts.


Recovering payments from a client who breaches the terms of an agreement can be a daunting task, especially for disabled entrepreneurs. By following these steps—understanding the breach, communicating with the client, sending a formal demand letter, leveraging mediation or arbitration, engaging a debt collection agency, taking legal action, and utilizing disability advocacy services—you can improve your chances of a successful resolution. Remember to stay organized, professional, and persistent throughout the process.

Unbeknown to the majority of our followers, the editor of DisabilityUK.co.uk and DisabledEntrepreneur.uk is planning to study Law later this year to better advise her readers in the future and fight for their rights. Meanwhile, she is an affiliate of First4Lawyers.com and drives leads to their website in exchange for a commission.

Further Reading: