Abrupt and Severe Obsessive-Compulsive Disorder in an 11-Year-Old Girl—PANDAS/PANS Syndrome: An Entity to be Considered—Management Implications. Issue 5 (June 2020)

• Record Type: Journal Article
• Authors: Khodayar-Pardo, Parisá; Álvarez-Bravos, Laura
• Is Part Of: Journal of developmental and behavioral pediatrics. Volume 41:Issue 5(2020)
• Publication Date: 2020-06
• Subjects: obsessive-compulsive disorder -- PANDAS/PANS syndrome; Child development -- Periodicals; Developmental disabilities -- Periodicals; Behavior disorders in children -- Periodicals; Learning disabilities -- Periodicals; Child psychiatry -- Periodicals; 618.92805
• DOI: 10.1097/DBP.0000000000000807
• Languages: English
• ISSNs: 0196-206X

Abstract

Abstract : CASE: An 11-year-old preadolescent girl was taken to the pediatric emergency room by her parents because of emotional overload. Her clinical history started 3 weeks before the visit, coinciding with a self-limited gastrointestinal infection affecting the whole family. Her obsessive behavior first appeared in the school setting; she tried to write perfectly, needing to make repeated corrections and ripping out multiple sheets from her notebooks when she made mistakes. She quickly developed new obsessions in diverse areas that progressively took over her life. When crossing the street, she initially avoided stepping on the zebra crossing lines, which recently progressed to needing to be carried across the pedestrian crossings, becoming greatly distressed if her parents refused. She also developed symmetry compulsions, requiring others to participate in them to avoid frustrating her, for example, asking anyone who touched her clothes to repeat the action for a similar length of time on the opposite side with a perfect symmetry, adopting the same position like a mirror image. There were no superstitions or psychotic features associated with these behaviors. The rituals progressively affected all areas of life (school, family, and friends) and had become highly maladaptive. Being aware of the peculiarity of her symptoms, at school, she tried unsuccessfully to hide them, feeling increasingly anxious. On the day of the hospital visit, she felt so overwhelmed by distress and the need for rituals that she was unable to get out of bed to go to school, describing a compulsion to rearrange the sheets and pillows in a specific way that was impossible to achieve. Her concerned parents decided to take her to hospital.