Posters
Academic Level (Author 1)
Medical Student
Academic Level (Author 2)
Faculty
Discipline/Specialty (Author 2)
Psychiatry
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Psychiatry
Discipline Track
Patient Care
Abstract
Background: This case report presents the diagnosis and management of Obsessive Compulsive Disorder (OCD) and Other Specified Anxiety Disorders in an 8-year-old male. The importance lies in the development of psychiatric symptoms after multiple respiratory infections and the subsequent diagnosis of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). It highlights a potential connection between infections and psychiatric manifestations in pediatric patients. PANDAS is an immune-mediated neuropsychiatric disorder that occurs after a Group A Strep (GAS) infection, characterized by the sudden onset or worsening of obsessive-compulsive disorder and tic disorder. While pathophysiology is not fully understood, evidence indicates that preceding GAS infections lead to an abnormal immune response, producing cross-reactive, anti-neuronal antibodies.
Presentation: 8-year-old male who developed anxiety and compulsive behaviors following several respiratory infections in early 2024. His OCD symptoms included intrusive thoughts about vomiting and compulsive behaviors such as seeking reassurance and counting, significantly impairing his daily functioning. He exhibited avoidance behaviors, carefully monitoring his food intake and avoiding physical activities to prevent vomiting.
Additionally, he displayed symptoms of Other Specified Anxiety Disorders, characterized by excessive worries about his parents' safety, getting lost, others’ opinions, nightmares about separation, and somatic symptoms when his parents were away. These symptoms, such as feeling hot and anxious, led to notable distress and interference with his school attendance and social activities. At the worst of his symptoms, he was withdrawn and preoccupied with worrying. His parents report that within a few days of starting sertraline, his symptoms began improving.
Following a diagnosis of PANDAS by his pediatrician, he was started on a treatment of antibiotics, a steroid shot, Naproxen, and Sertraline 50 mg daily. Though there has been progress over time, his parents report some anxiety-related thoughts and behaviors have persisted.
During his visit, he reported good energy levels, sleep, and appetite, and he continued engaging in sports and social activities. The treatment plan included assessment via the Screen for Child Anxiety-Related Disorders (SCARED) form – he scored a 29 (a total score of ≥ 25 indicates the possible presence of an anxiety disorder).
The plan included continuing Sertraline 50 mg daily, Cognitive Behavioral Therapy (CBT) for anxiety and OCD and implementing a 504 plan at school. He and his parents were provided with education on anxiety and OCD, an anxiety worksheet, and the instructions for the worksheet. The patient was scheduled to be re-evaluated in 6 weeks to assess treatment efficacy and make necessary adjustments.
Conclusions: This case underscores the importance of considering infectious etiologies in the differential diagnosis of sudden-onset psychiatric symptoms in pediatric patients. The positive response to Sertraline and the proposed CBT highlights the potential benefits of a combined pharmacological and therapeutic approach in managing OCD and anxiety disorders. Continued follow-up and treatment adaptation is essential to ensure sustained improvement and quality of life for pediatric patients with similar presentations.
Presentation Type
Poster
Recommended Citation
Tran, Michael; Amador, Alcides; and Camacho Bermudez, Sofia, "Obsessive Compulsive Disorder and Other Specified Anxiety Disorder in an 8-Year-Old Post-respiratory Infection: A Case Report" (2024). Research Colloquium. 91.
https://scholarworks.utrgv.edu/colloquium/2024/posters/91
Included in
Obsessive Compulsive Disorder and Other Specified Anxiety Disorder in an 8-Year-Old Post-respiratory Infection: A Case Report
Background: This case report presents the diagnosis and management of Obsessive Compulsive Disorder (OCD) and Other Specified Anxiety Disorders in an 8-year-old male. The importance lies in the development of psychiatric symptoms after multiple respiratory infections and the subsequent diagnosis of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). It highlights a potential connection between infections and psychiatric manifestations in pediatric patients. PANDAS is an immune-mediated neuropsychiatric disorder that occurs after a Group A Strep (GAS) infection, characterized by the sudden onset or worsening of obsessive-compulsive disorder and tic disorder. While pathophysiology is not fully understood, evidence indicates that preceding GAS infections lead to an abnormal immune response, producing cross-reactive, anti-neuronal antibodies.
Presentation: 8-year-old male who developed anxiety and compulsive behaviors following several respiratory infections in early 2024. His OCD symptoms included intrusive thoughts about vomiting and compulsive behaviors such as seeking reassurance and counting, significantly impairing his daily functioning. He exhibited avoidance behaviors, carefully monitoring his food intake and avoiding physical activities to prevent vomiting.
Additionally, he displayed symptoms of Other Specified Anxiety Disorders, characterized by excessive worries about his parents' safety, getting lost, others’ opinions, nightmares about separation, and somatic symptoms when his parents were away. These symptoms, such as feeling hot and anxious, led to notable distress and interference with his school attendance and social activities. At the worst of his symptoms, he was withdrawn and preoccupied with worrying. His parents report that within a few days of starting sertraline, his symptoms began improving.
Following a diagnosis of PANDAS by his pediatrician, he was started on a treatment of antibiotics, a steroid shot, Naproxen, and Sertraline 50 mg daily. Though there has been progress over time, his parents report some anxiety-related thoughts and behaviors have persisted.
During his visit, he reported good energy levels, sleep, and appetite, and he continued engaging in sports and social activities. The treatment plan included assessment via the Screen for Child Anxiety-Related Disorders (SCARED) form – he scored a 29 (a total score of ≥ 25 indicates the possible presence of an anxiety disorder).
The plan included continuing Sertraline 50 mg daily, Cognitive Behavioral Therapy (CBT) for anxiety and OCD and implementing a 504 plan at school. He and his parents were provided with education on anxiety and OCD, an anxiety worksheet, and the instructions for the worksheet. The patient was scheduled to be re-evaluated in 6 weeks to assess treatment efficacy and make necessary adjustments.
Conclusions: This case underscores the importance of considering infectious etiologies in the differential diagnosis of sudden-onset psychiatric symptoms in pediatric patients. The positive response to Sertraline and the proposed CBT highlights the potential benefits of a combined pharmacological and therapeutic approach in managing OCD and anxiety disorders. Continued follow-up and treatment adaptation is essential to ensure sustained improvement and quality of life for pediatric patients with similar presentations.