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Pediatric acute-onset neuropsychiatric syndrome

最后审阅: 20 Aug 2025
最后更新: 10 Nov 2023

小结

定义

病史和体格检查

关键诊断因素

  • acute-onset (<72 hours) obsessive-compulsive disorder (OCD)
  • acute-onset (<72 hours) severely restricted food intake
  • acute-onset (<72 hours) concurrent neuropsychiatric symptoms
  • relapsing-remitting course
完整详情

其他诊断因素

  • current or past group A streptococcus (GAS) infection
  • motor signs associated with basal ganglia dysfunction
  • sinusitis, otitis media, and other sinopulmonary infections
  • systemic inflammation/immune dysregulation
  • enuresis
  • frequent urination
  • sleep disturbances
  • dehydration
  • palatal petechiae
  • low body mass index (BMI)
  • vital sign instability
完整详情

危险因素

  • prepubescent onset
  • family history of psychiatric disorder
  • family history of autoimmunity
  • history of developmental disorder
  • immune dysfunction
  • male sex
  • history of infection
完整详情

诊断性检查

首要检查

  • clinical diagnosis
  • throat culture for group A streptococcus (GAS)
  • polymerase chain reaction (PCR) for group A streptococcus (GAS)
  • rapid antigen detection test (RADT) for group A streptococcus (GAS)
  • antistreptococcal serology
  • CBC with differential
  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • comprehensive metabolic panel
  • antinuclear antibodies (ANA)
  • immunoglobulins (IgG, IgA, IgM, IgE) with IgG subclasses
  • ferritin (iron) and transferrin saturation
完整详情

需考虑的检查

  • urinalysis
  • brain MRI
  • electroencephalogram (EEG)
  • lumbar puncture
  • polysomnogram
  • musculoskeletal imaging (MRI or ultrasound)
  • swallowing studies
完整详情

治疗流程

急症处理

new-onset or new flare: mild impairment

new-onset or new flare: moderate to severe impairment

new-onset or new flare: extreme or life-threatening impairment

持续性治疗

chronic symptoms

撰稿人

作者

Jennifer Frankovich, MD, MS

Professor Pediatrics - Allergy, Immunology, Rheumatology

Co-Director, Stanford Children’s Immune Behavioral Health Clinic

Director, Stanford Immune Behavioral Health Research Program

Stanford University School of Medicine

Stanford

CA

利益声明

JF declares that she has no competing interests.

Yuhuan Xie, MD

Clinical Assistant Professor

Psychiatry and Behavioral Sciences - Child & Adolescent Psychiatry and Child Development

Stanford University School of Medicine

Stanford

CA

利益声明

YX declares that she has no competing interests.

同行评议者

Juliette C. Madan, MD, MS

Associate Professor Pediatrics, Psychiatry & Epidemiology

Clinical Director of the Children's Environmental Health and Disease Prevention Research Center

Geisel School of Medicine at Dartmouth

Dartmouth Hitchcock Medical Center

Hanover

NH

利益声明

JCM declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Pfeiffer HCV, Wickstrom R, Skov L, et al. Clinical guidance for diagnosis and management of suspected pediatric acute-onset neuropsychiatric syndrome in the Nordic countries. Acta Paediatr. 2021 Dec;110(12):3153-60.全文  摘要

Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):3-13.全文  摘要

Cooperstock MS, Swedo SE, Pasternack MS, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part III-treatment and prevention of infections. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):594-606.全文  摘要

Frankovich J, Swedo S, Murphy T, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part II-use of immunomodulatory therapies. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):574-93.全文  摘要

Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I-psychiatric and behavioral interventions. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):566-73.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • 鉴别诊断

    • Obsessive-compulsive disorder (OCD)
    • Anorexia nervosa
    • Avoidant-restrictive food intake disorder (ARFID)
    更多 鉴别诊断
  • 指南

    • Clinical guidance for diagnosis and management of suspected pediatric acute-onset neuropsychiatric syndrome in the Nordic countries
    • Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference
    更多 指南
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