Is it ODD or PANS/PANDAS?

With cases of PANS/PANDAS on the rise due to the increase of infectious disease, PANS, PANDAS and autoimmune encephalopathy (AE) and similarly to ODD, they should always be ruled out as a source of oppositional and defiant behaviors, especially when there is a sudden onset.

Without a situational stressor or a traumatic event precipitating a sudden behavioral change, we need to look for root causes, so the underlying issue can be addressed properly. Diseases such as Lyme and tick-borne disease, epstein-barr, mold, viruses, long hauler COVID, and other infectious and toxin triggers can trigger behaviors that can look like or contribute to clinical conditions such as Oppositional Defiant Disorder (ODD), anxiety, Bipolar Disorder, OCD, Autism, and so on. 

How Does Infectious Disease Impact the Brain and Behavior?

We have learned a lot about how infectious disease impacts the brain and mental health through studying those with Lyme Disease and other tick-borne illnesses. 

Lyme and tick-borne disease are well documented to cause a variety of mental health conditions including but not limited to anxiety, depression and mood disorders, sensory processing issues, attentional issues,and learning and memory difficulties. It is no surprise that the stress of the disease alone and the physical toll it takes on the brain and body would lead to an increase in difficulties with anxiety, mood, attention and processing. Research in 2021 (Fallon, Madsen, Erlangsen, and Benros) found that individuals with Lyme had higher rates of any mental disorder, of affective disorders, of suicide attempts and of death by suicide when compared with those without Lyme.

How Does Stress Impact Mental Health?

Stress is the greatest threat to our physical and mental health and yet we aren’t educating our physicians, mental health providers and patients enough (or really at all) about what they can do to support their own or their child’s stress management system, the autonomic nervous system (ANS). 

What we have learned from psychoimmunology is that when the ANS is in a hyper stress-activated sympathetic dominant state, not only does a person feel the physical effects of stress, but one’s entire body’s resources kick into gear and “prepare for war.” Chronic stress puts our ANS in a “rev state” and makes it hard, if not impossible, for the body to use it’s resources to attack infectious disease. Unfortunately, untreated or unresolved Lyme is a constant stressor for the ANS and when the body should be using its resources to heal Lyme, it can’t because of this physiological stress response. 

What Does PANS/PANDAS Look Like in Children?

PANS and PANDAS are two distinct disorders that result from different infectious sources but  both produce similar neuropsychiatric and neurocognitive issues and have a sudden onset. Even though the “P’ in PANS and PANDAS stands for pediatric, the onset doesn’t just have to be in childhood and now one can have an adult onset.

With PANS, PANDAS, and autoimmune encephalopathy (AE), there can be a variety of clinical issues including but limited to:

• Anxiety
• Separation Anxiety
• Emotional Lability and/or depression
• Irritability, aggression and/or severely oppositional behaviors
• Behavioral (developmental) regression
• Deterioration in school performance
• Loss of motor or writing skills
• Sensory or motor abnormalities
• Somatic signs and symptoms
• Sleep disturbance
• Enuresis or urinary frequency
• Obsessive-Compulsive Behavior
• Motor or vocal tics

Symptoms can wax and wane over time with intense periods of psychiatric and behavioral issues. There can also be a slow progression of symptoms, especially with autoimmune encephalopathy. It is very important to realize that a person can have pre-existing issues that exacerbate with infectious disease or a toxic trigger. For example, a child or person can have anxiety that accelerates quickly and morphs into panic attacks, OCD, or depression. An individual can have no pre-existing mental health issues either, which certainly makes it more noticeable and thereby one is more likely to get treatment. 

To learn more about the clinical criteria for PANS and PANDAS, read my blog, Does My Child Have PANS/PANDAS?

Is it ODD or PANS, PANDAS, or AE?

Oppositional behaviors are par for the course when it comes to PANS, PANDAS, and AE.  Infection and toxins agitate the nervous system and it is reflected in dysregulated behaviors.

In my 30 years of clinical experience, I have never seen oppositional behaviors happen without a root cause in something else. Parents should never accept a clinical diagnosis of  Oppositional Defiant Disorder (ODD) without digging deeper to find out what is behind the behavior and due to behavioral similarity, PANS, PANDAS, and AE should always be ruled out. 

How Do You Treat PANS, PANDAS, and AE? 

Treatment for PANS, PANDAS, and AE involves a combination of treatment of the infection and/or toxin, reduction of inflammation, and behavioral/ psychological treatment.

Having treated thousands of kids and adults with Lyme, PANS/PANDAS, and other infectious diseases with neurofeedback, biofeedback, and PEMF, working with a highly experienced PANS/PANDAS provider is critical in improving symptoms. Many people seek out Dr. Roseann’s expertise because of her trademarked BrainBehaviorReset™ Method. 

To learn more about how neurofeedback can reduce anger and noncompliance symptoms, read my blog, Neurofeedback for PANS and PANDAS. 

Want to learn more about ODD and how to identify root causes and treat noncompliant and defiant behaviors, read my blog:

• Is it ODD or Something Else?

Citation:

Brian A. Fallon, Trine Madsen, Annette Erlangsen, Michael E. Benros. Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. American Journal of Psychiatry, 2021; appi.ajp.2021.2 DOI: 10.1176/appi.ajp.2021.20091347