From: hounddog23x@gmail.com   
      
   The Wall Street Journal   
      
   U.S.   
      
      
   Can an Infection Trigger OCD?   
      
   Proposed link between infections and psychiatric disorders is still under   
   review but gaining more recognition, resources among scientists   
      
      
   Diana Pohlman at home in Menlo Park, Calif., with her family, including son   
   Garrett, 15, who developed sudden psychiatric symptoms at age 7. The   
   experience prompted Ms. Pohlman to found an advocacy group for PANS, or   
   pediatric acute-onset    
   neuropsychiatric syndrome.   
   Diana Pohlman at home in Menlo Park, Calif., with her family, including son   
   Garrett, 15, who developed sudden psychiatric symptoms at age 7. The   
   experience prompted Ms. Pohlman to found an advocacy group for PANS, or   
   pediatric acute-onset    
   neuropsychiatric syndrome. PHOTO: PRESTON GANNAWAY FOR THE WALL STREET JOURNAL   
      
      
   By AMY DOCKSER MARCUS   
   July 12, 2015 4:54 p.m. ET   
   20 COMMENTS   
      
      
      
   MENLO PARK, Calif.--At the age of 7, Garrett Pohlman came home from the first   
   day of second grade and was "a totally different person," his mother said.   
   Garrett experienced a sudden and dramatic onset of obsessive-compulsive   
   disorder and other symptoms.    
   He was weeping and terrified to go back to school.   
      
   At the time, Garrett had also been battling case after case of strep throat.   
   His mother, Diana Pohlman, thought there might be a connection.   
      
   Doctors and psychiatrists have long debated whether there is a link between   
   infections and certain psychiatric disorders, including OCD.   
      
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   During the past few years, the notion has been earning more recognition in the   
   scientific community. Resources have followed, including the creation in 2012   
   of a Stanford University clinic dedicated to studying and treating the   
   condition, known most    
   commonly as PANS, for pediatric acute-onset neuropsychiatric syndrome.   
      
   About 1% of children and adolescents in the U.S. have OCD, which can include   
   symptoms such as fears of contamination and repetitive actions such as   
   hand-washing. But since no large population studies have been done on the   
   condition, no one knows how many    
   of those cases might be considered PANS. Not all pediatric specialists agree   
   PANS is a distinct disorder.   
      
   Some doctors say that children should be tested for infections such as strep   
   throat if they experience dramatic and sudden-onset OCD to see if treatment   
   with antibiotics improves symptoms. In some cases where pediatric patients   
   have multiple relapses    
   associated with strep infections, long-term use of antibiotics might be   
   effective in preventing them, the doctors say.   
      
   Others contend that, until the data show a stronger connection, children   
   should get standard care for OCD, usually cognitive-behavioral therapy and   
   antidepressants.   
      
   RELATED COVERAGE   
      
   5 Things to Know About PANS (July 12, 2015)   
   Strep Throat as Trigger for Serious Ills (Dec. 13, 2011)   
   In a special issue of the Journal of Child and Adolescent Psychopharmacology   
   devoted to PANS published earlier this year, researchers of one paper studied   
   the first 47 patients who came through the Stanford clinic and found that no   
   one set of symptoms or    
   causes tied the cases together neatly.   
      
   For instance, only 40% of the patients in the study had an acute onset of   
   their symptoms, which many consider the very heart of the definition of the   
   disorder.   
      
   Donald L. Gilbert, a neurologist at Cincinnati Children's Hospital Medical   
   Center, said he doesn't believe the data support treating sudden-onset OCD   
   with antibiotics, infusions of antibodies or steroids, all of which have been   
   used to treat PANS.   
      
   "The long-term course is not different" than other types of OCD, he said. With   
   or without an infection, these children would have gotten OCD anyway, he   
   argued, and most children also respond to the standard therapies.   
      
   Still, "I think there ought to be a continuing quest to understand things that   
   cause suffering that we don't treat well," Dr. Gilbert said, "and psychiatric   
   illnesses fall in that category."   
      
      
   A network of physicians, including at Massachusetts General Hospital in   
   Boston, the University of South Florida and elsewhere, hold regular conference   
   calls sharing strategies on treating PANS patients and running trials.   
      
   Nowhere is the change in approach more noticeable than in the heart of Silicon   
   Valley, where the PANS clinic at Stanford's Lucile Packard Children's   
   Hospital--fueled in part by advocacy of parents like Ms. Pohlman and the local   
   entrepreneurial ethos--is    
   adding medical staff during the summer and fall.   
      
   The clinic has seen 150 patients since it opened three years ago and has a   
   long waiting list. The clinic currently sees only patients who live within a   
   90-mile radius. Even so, it can't keep up.   
      
   The cost of running the clinic is funded by Stanford Children's Health and the   
   Lucile Packard hospital. Other backing is being provided by the National   
   Institute of Mental Health, including research support to build a PANS   
   database and biological-   
   materials repository.   
      
   Stanford convened the First PANS Consensus Conference in 2013 and researchers   
   in the growing field came up with recommendations on how to diagnose patients   
   that were published earlier this year.   
      
   Researchers met at the NIMH for a second conference last year, and a third one   
   is planned for the fall. The scientists plan to finalize guidelines on how to   
   treat PANS and create a database to track how patients at different   
   institutions fare on various    
   treatments.   
      
   Ms. Pohlman, who lives down the street from Stanford, said that when Garrett's   
   symptoms cropped up eight years ago, long before the clinic opened, she had to   
   cobble together treatment for him from a range of specialists.   
      
   Her son, now 15 years old, took antibiotics off and on for a year before   
   receiving infusions of antibodies from healthy donors, known as intravenous   
   immunoglobulin, or IVIG, and today has no signs of OCD or tics, Ms. Pohlman   
   said. The experience prompted    
   her to found an advocacy group that funds research and runs conferences where   
   families and scientists mingle. Ms. Pohlman describes the efforts to get   
   attention for the condition as being "like a startup" in that families have   
   helped drive attention and    
   resources to the disorder.   
      
   Jennifer Frankovich, a pediatric rheumatologist at Lucile Packard and director   
   of the Stanford PANS clinic and research program, said the idea to set up a   
   dedicated clinic grew from seeing patients who had both medical and   
   psychiatric symptoms. Some    
   noted improvement in the psychiatric symptoms after their medical condition   
   was treated.   
      
      
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