How common infections can lead to mental health issues in kids
• And why do so many physicians fail to recognize it?
On a bright September day in 2007, seven-year-old Garrett Pohlman returned from his school. Weeping, he alerted his mother to the radiation emanating from the electrical outlets in the house. He warned them that birds would peck them to death if they went outside. There were peculiar facial movements that went along with these statements. The boy would jerk his arms and legs and stick out his tongue. Garrett had been your typical boy the day before. The tics and the paranoia had come on suddenly, but they turned out to be the beginning of a terrifying mental breakdown.
Garrett ended up getting lucky. Three months later, a bacterial sinus infection was discovered by a hospital scan. After taking antibiotics for the infection, his psychiatric symptoms significantly improved. PANDAS, or Paediatric Autoimmune-Neuropsychiatric Disorders Associated with Streptococcus, was Garrett's ailment.
Numerous other kids are not as lucky; some have sustained permanent harm. To put it simply, Garrett's strange behavior was brought on by an immune system that went crazy after contracting group A Streptococcus, a common bacteria. (PANS, or paediatric acute-onset neuropsychiatric syndrome, is the abbreviation for a related condition that can be brought on by other infections.)
However, a lot of physicians are unaware of PANDAS or PANS. They've been written off by some as imaginary illnesses. Very few nations provide recommendations for their diagnosis or course of care. Garrett's mother, Diana Pohlman, describes herself as "exhausted" after years of advocating for doctors to treat the illnesses seriously.
Things are beginning to change with that. Researchers are starting to identify the precise causes of the illnesses and provide a detailed description of the symptoms for those who are affected. British health minister Maria Caulfield weighed in on September 12th, informing lawmakers that PANDAS and PANS are real conditions that are brought on by infections.
These initiatives are getting off to a poor start. 95% of parents whose children have PANDAS reported that their family doctors had not disclosed the diagnosis in a 2020 survey conducted for the charity PANS PANDAS UK, indicating a low level of awareness. The situation among experts was not much better. Approximately 50% of pediatricians stated they were unaware of the illness. Almost half of the parents who responded to the survey said their pediatrician thought the diagnosis was debatable.
There are expenses associated with ignorance. Children with PANDAS are frequently given a confusing array of psychiatric misdiagnoses in various countries. These can include sensory-processing disorders, autism, and attention-deficit hyperactivity disorder. It is possible to give children inappropriate medications, such as antipsychotics, which have unpleasant side effects and are ineffective in treating.
Parents have occasionally been charged with creating or causing the ailments that afflict their kids. Parents who have spoken with The Economist claim that their children have been taken out of their care entirely or forced into mental health services against their will. A doctor reportedly told a child that he would not treat "an American illness," according to testimony given in Parliament. A British hospital released several dozen children with PANDAS and PANS in 2019. The diagnosis given to their parents was that they had a "functional neurological disorder," which some doctors grimly translate as "finding no diagnosis." This diagnosis has evolved from the outdated and debunked theory of hysteria.
It's unclear exactly why the diagnosis is debatable. After all, it's not exactly novel to suggest that psychological symptoms may arise from an infection's aftermath. Similar to sydenham's chorea, a streptococcal infection causes jerky movements of the face and body in affected individuals. The Economist sought comments from a number of professional associations and psychiatrists. A few chose not to respond. Some stated that they were unable to comment. Finding a suitable spokesperson was proving to be difficult, according to the Royal College of Psychiatrists.
• The physical and mental
But opinions are starting to change as proof grows that PANS and PANDAS exist. Researchers studying the illness now think that brain tissue is attacked by the body's immune system in an auto-immune reaction. According to the theory, children who contract Streptococcus start making antibodies that lead to inflammation in their own brains, which ultimately results in psychiatric symptoms.
Yale University psychiatrist Christopher Pittenger and his associates took antibodies out of PANDAS-affected children's blood in 2018 and gave them to lab mice. They discovered that the antibodies specifically targeted cholinergic interneurons, a subset of neurons in brain regions linked to tic disorders, which are a characteristic of PANDAS. The PANDAS phenotype and antibodies that target dopamine receptors D1 and D2, according to researcher Chandra Menendez of the University of Oklahoma Health Sciences Center, are correlated. Such research could aid in the creation of diagnostic exams.
According to a study by Columbia University neurologist Dritan Agalliu that is presently being reviewed by a scientific journal, immune-suppressive medications may lessen brain damage in mice by inhibiting T helper 17 cells, a specific type of lymphocyte that is part of the immune system. According to additional research, there may also be a role for harm to the blood-brain barrier, which serves as a filter to shield the brain from potentially dangerous chemicals in the blood.
These results might mean more than just one rare and crippling disease. Because they align with an intriguing and expanding body of evidence suggesting infections may also be the cause of other psychiatric conditions. It is now evident, according to Dr. Pittenger, that COVID-19 infections can result in neuropsychiatric symptoms such as fatigue and psychosis. It is believed that an immune system in disarray is to blame. Research is also being done on the theory that schizophrenia could, on occasion, likewise be an autoimmune condition. (Interestingly, there seems to be a 40% increased risk of developing psychotic disorders like schizophrenia in individuals with any type of auto-immune disease.)
It is another matter entirely how long it takes for doctors to recognize this shift in perspective. Governments, rather than patients, are now the ones who poke and prod occasionally. The British government, according to British MP Robin Millar, who is in charge of a parliamentary group on PANDAS and PANS, is dedicated to figuring out how to identify and evaluate the conditions. It is considering a research project to determine the prevalence of the diseases and has started talking with doctors about it. Moreover, the 2018 founding of the pan-European patient organization EXPAND is working to advance comprehension.
We really need to make these efforts. The case of Garrett Pohlman demonstrates that early detection of infections can lead to very effective treatment and prevent long-term damage. Mr. Pohlman, who is currently 23 years old, founded his own business after earning a chemical engineering degree with honors from the University of California, Berkeley in 2022. Not all patients have had such good fortune.
Correction (September 22, 2023): This article originally mentioned using anti-inflammatory medications to lessen brain damage. Actually, immunosuppressive medications were taken. I apologize for the mistake.