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Patient Satisfaction and Treatments Offered to Swedish Patients with Suspected Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections
Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-3587-6075
2019 (English)In: Journal of child and adolescent psychopharmacology, ISSN 1044-5463, E-ISSN 1557-8992Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are subtypes of Obsessive-Compulsive Disorder (OCD) with suggested autoimmune etiology. Immunomodulatory treatments have been introduced as treatment options. A recent systematic review concluded that the evidence for all treatment options for PANS and PANDAS is inconclusive. However, case reports and clinical experience suggest that antibiotics and immunomodulatory treatment may be helpful. Treatment may also affect the patients' satisfaction with health care services offered. This study aims to describe the treatments given to a cohort of Swedish patients with suspected PANS and PANDAS, the patient rated treatment effects, and to establish if any specific treatment predicts higher patient satisfaction.

Methods: Fifty-three patients (m = 33, f = 20, median age = 14, age range = 4-36) with suspected PANS or PANDAS were enrolled and assessed for PANS and PANDAS caseness, treatments given, treatment effects, global improvement, and patient satisfaction. Cases with confirmed and suspected PANS or PANDAS were compared regarding the frequency of treatments given and treatment effect. A linear regression model was used to see if treatments given or global improvement predicted patient satisfaction.

Results: Twenty-four participants fulfilled criteria for PANS or PANDAS and 29 did not. The most common treatments given were antibiotics (88%), nonsteroidal anti-inflammatory drugs (67%), cognitive behavioral therapy (53%), and selective serotonin reuptake inhibitors (42%). There were no major differences between confirmed and suspected cases regarding what treatments they had received or their effect. Patient satisfaction was predicted by overall clinical improvement at the time of assessment. Antibiotics and intravenous immunoglobulin (IVIG) were rated as the most successful treatments by participants and were associated with higher patient satisfaction.

Conclusions: It was more common that patients had received antibiotics than common psychiatric treatments for their psychiatric symptoms. Antibiotics and IVIG were experienced as effective treatments by the patients. Patient satisfaction was on average moderately low, and higher patient satisfaction was associated with global clinical improvement.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2019.
Keywords [en]
Obsessive-compulsive disorder, patient satisfaction, pediatric acute-onset neuropsychiatric syndrome, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, treatment outcome
National Category
Rheumatology and Autoimmunity Pediatrics Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-73898DOI: 10.1089/cap.2018.0141ISI: 000465469300001PubMedID: 31009235OAI: oai:DiVA.org:oru-73898DiVA, id: diva2:1306538
Funder
Swedish Research Council, 523-2011-3646The Swedish Brain Foundation, FO2015-0191
Note

Funding Agencies:

Bror Gadelius Minnesfond  

Psykiatrifonden  

Stockholm County Council (PPG projects)  20130671  20150150 

Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-06-20Bibliographically approved

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Bejerot, Susanne

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