SANE Sweden 2019 International PANS Conference

The SANE 2019 International PANS Conference took place October 3 and 4, 2019, in Malmo, Sweden, the third largest city in Sweden, just 30 min north of Copenhagen. The organizers of SANS Sweden, a parent-led support/education outreach group based in Stockholm, obtained grants from Sweden and spent 3 years organizing this 2-day conference of professional and parents - over 350 total. It was both refreshing and sad to see that families’ stories of PANS affecting their children were very similar among attendees from Sweden, Denmark, Italy, Germany, the UK, Canada, and very similar to those I have heard over the years in the US. It was clear that we were all speaking the same language - that PANS/PANDAS exists, hits quickly, and often hits hard. The conference allowed for meal times for professionals and parents to mingle and discuss - I had many long discussions with attendees about their experiences in getting a diagnosis and proper treatment - some having to fly to the US. Many are still looking for a treatment team. One thing I noticed was that corticosteroids appear to be used much less in Europe than in the US. Rather, IVIG is seen as one of the primary treatments of PANS. The health care system being universal and covered by the government made it both easier and more difficult to obtain IVIG - use was closely monitored, but at least when able to be obtained, treatment was free.

The professional presentations included data and discussions regarding autoimmunity in autism (Richard Frye, M.D., Associate Professor, Arizona Children’s Hospital in Phoenix), Immunopsychiatry in adults with treatment resistant disorders such as OCD and schizophrenia (Suzanne Bejerot, M.D., Ph.D. , Professor of Psychiatry, Örebro University, Sweden and Janet Cunningham, MD, PhD, Associate Professor of Psychiatry, Uppsala University, Sweden) , and researchers from Gothenberg and FInland detailing POTS and PANS and their experiences researching these areas. Relatively new PANS Clinics in the UK and in Stockholm described their approaches and early data from their patients.

Closer from home, Jennifer Frankovich, M.D. (Clinical Associate Professor, Stanford University School of Medicine) discussed latest findings regarding inflammation in patients from the Stanford PANS Clinic, and Cynthia Kappahn M.D. (Clinical Professor, Stanford) discussed her experience treating youth with eating disorders, particularly those with PANS-related disorders.

Perhaps the most moving part of the conference came when a mother described her and her daughters journey with PANS. her daughter is now pursing a career in music and she performed for he audience two original songs, with accompanied guitar, that brought down the house.

The two-day conference was a huge success - in providing much needed information and support to families as well as information sharing and collaborations among researchers and clinicians. Speakers were warmly welcomed - some pictured here in the Malmo Town Hall meeting with the mayor - the first woman mayor of Malmo!

Red Panda is a Bay Area Treasure

I know you have heard of PANS and PANDAS by now, but have you heard of Red Panda? She is a Bay Area treasure! She was born in China and both her parents were acrobats. They chose her skill to learn at age 7: riding a unicycle while balancing bowls on her feet and flipping them onto her head. After 4 years of practice, she performed in public at age 11, and didn’t drop a single bowl! Here is her back story.

Red Panda Unicycle.jpg

Fast forward to now and she has been a popular halftime performer at NBA and college basketball games for the past 20+ years. She lives in San Francisco, and recently after having her unique custom unicycle stolen at SFO, the Golden State Warriors bought her a new one!

Red_Panda_Acrobat1980x1100_dl1gk4u5_cv35b4ko@2x.jpg

Incidentally, red pandas are a real thing and are super cute!

RedPandaFullBody.jpeg

New Study Links Infections in Children to Increased Risk for Mental Illness

December 5, 2018

A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents

Ole Köhler-Forsberg, MD1,2,3Liselotte Petersen, PhD4,5Christiane Gasse, PhD4Preben B. Mortensen, DrMedSci4,5,6Soren Dalsgaard, PhD4,7Robert H. Yolken, MD8Ole Mors, PhD1,2,5;Michael E. Benros, PhD3,4

JAMA Psychiatry. Published online December 5, 2018. doi:10.1001/jamapsychiatry.2018.3428

This study was another great example of how Scandanavian health registries can generated much needed public heath data. The study describes looking at all records of infection from 2015-2017, from over 1 million children born in Denmark from 1995 - 2012, and correlating those cases with any recorded contact with a mental health provider subsequently. The authors found that any history of infection needing hospitalization in childhood raised the risk of developing a psychiatric disorder by 84%, and any infection treated by antibiotics for some period were linked to increases in risk for mental illness health contacts by 40%. The authors state “The risk of mental disorders after infections increased in a dose-response association and with the temporal proximity of the last infection. In particular, schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autistic spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections.” One more piece of evidence in the vast literature about infections being one likely cause of these disorders, particularly psychotic disorders, OCD, autism, and tic disorders.

Medscape Series on Pediatric Bipolar Depression

Medscape recently launched a two part CME educational series on pediatric bipolar depression, featuring myself and Dr. Melissa DelBello, Chair of Psychiatry at the University of Cincinnati School of Medicine.  Dr. Roger McIntyre, Professor of Psychiatry at the University of Toronto, joins us in moderating a discussion on therapeutic approaches to youth with bipolar depression in Part 2.  The format is interesting as it is a discussion among colleagues and was not scripted, but a topic outline was followed.  Viewing it may require a Medscape subscription.

  • Diagnosing Pediatric Bipolar Depression: Why It's Harder Than You Think
  • Link: https://www.medscape.org/viewarticle/890958
  • Format:  Extended Curbside Consult
  • Launch Date: March 07, 2018
  • Faculty: Kiki Chang, MD; Melissa DelBello, MD, MS
  • Goal: The goal of this activity is to improve clinical practice in the diagnosis of pediatric bipolar depression.
  • Upon completion of this activity, participants will:
    • Have greater competence related to incorporation of validated assessment instruments for pediatric patients with bipolar depression
    • Have greater competence related to diagnosing pediatric bipolar depression
    • Demonstrate greater confidence in their ability to communicate with caregivers/patients to develop management strategies for pediatric bipolar depression
  • Additionally, the activity is further augmented by a Linked Learning Assessment, which measures the overall effect of the education and assesses changes in knowledge and competency on a per-learner and overall-participant basis.
  • Title: Scientific Update: Therapeutic Considerations for Pediatric Bipolar Depression
  • Link: https://www.medscape.org/viewarticle/89681 7
  • Format:  Ex pert Panel Discussion with Downloadable Patient Handout
  • Launch Date:  June 14, 2018
  • Faculty:  Roger S. McIntyre, MD, FRCPC; Melissa DelBello, MD, MS; Kiki Chang, MD
  • Goal:  The goal of this activity is to provide an update on the latest data regarding the treatment of pediatric bipolar depression and to discuss roles and difficulties that are encountered by various clinicians who may encounter pediatric patients with bipolar depression  .
  • Upon completion of this activity, participants will:
    • Have increased knowledge regarding the management goals for pediatric bipolar depression
    • Have increased knowledge reagarding clinical data on treatment options for pediatric bipolar depression
    • Have greater competence related to the selection of appropriate treatments for pediatric bipolar depression

Estonian Pediatric Neurology Society Holds PANS Conference

I was fortunate to be invited to speak at a PANS Conference organized by Inga Talvik, MD, head of the Estonian Pediatric Neurology Society, held at the beautiful child psychiatry facility affiliated with the Children's Hospital of Estonia, Laste Vaimse Tervise Keskus.  The conference was held on October 19-20, 2017, and was well attended by child psychiatrists and neurologists from throughout Estonia as well as colleagues Drs. Caroline Gromark and Maria Silverberg Morse from Stockholm.  It was fascinating to see that the cases of PANS in Estonia and Sweden were very similar to those in the U.S., and to learn of their research and treatment approaches.  I was able to share the recently published Expert Consensus Treatment Guidelines for Youth with PANS as well as some of the Stanford PANS Clinic experience and recently published data regarding NSAIDS and prednisone.

Additionally, I spoke on pediatric bipolar disorder to child psychiatrists at the courtesy of Anna Kleinberg, M.D. the Head of Child Psychiatry there.  The facility, Laste Vaimse Tervise Keskus, 2 years new, is beautiful, with inpatient and outpatient areas, all designed carefully, with soothing and pleasing art, color, and wide halls and open spaces.  They also have their own gymnasium there, and plenty of space for music therapy, group rooms, and rooms for parent meetings. More importantly, they are able to do extended evaluations where the children stay during the day and go home at night, when appropriate.  Dr. Kleinberg was able to get the facility built with hard work and grants from Norway! It was the kind of child psychiatric facility that I would be glad to go to work there every day.  I met several of the psychiatrists, therapists, and fellows who worked there and was impressed by their high quality and dedication to pediatric mental health.

Thank you Drs. Kleinberg and Talvik for an excellent meeting and exchange of international knowledge!

INECO Symposium in Buenos Aires brought together neuroscience researchers in depression

The symposium "New Approaches to Depression", put on by INECO at the Museum of Latin American Art Buenos Aires (MALBA) on October 4, 2017 was a success!  Featured speakers included Dr. Charles Nemeroff, Dr Leonardo Tondo, Dr. Kenneth Schulman, Dr. Danilo Rodriguez, and Dr. Sahib Khalsa.  INECO was founded 10 years ago in Argentina to bring together researchers from the fields of Neurology, Psychiatry, Neuropsychology, and related fields in order to push the field forward in Argentina in biological psychiatry.  INECO President Dr. Facundo Manes, Executive Director Dr. Teresa Torralva, and Head Psychiatrist Dr. Marcelo Cetkovich have worked tirelessly with sympoosium organizer Dr. Clara Rodriguez to put on this symposium and generate cross-talk and good will between the US, Argentina, and Chile. Thank you to INECO and their sponsors for a wonderful visit and event!

Group Melia.jpg

Altered pattern of brain connectivity development during youth linked to symptoms of depression and anxiety

Development of White Matter Microstructure and Intrinsic Functional Connectivity Between the Amygdala and Ventromedial Prefrontal Cortex: Associations With Anxiety and Depression

Maria Jalbrzikowskia, Bart Larsen, Michael N. Hallquistd, William Forana, Finnegan Calabroa, Beatriz Luna

Biological Psychiatry; 2017;82(7):511-522

Researchers at the University of Pittsburgh analyzed brain imaging data from 246 youth, taken at up to three time points 15 months apart, and found that certain patterns of functional connectivity development between the prefrontal cortex and the amygdala are associated with higher levels of depressive and anxious symptoms.  These findings closely parallel similar findings in youth with and at high risk for bipolar disorder.  I was honored to be asked to provide a commentary in the journal on this important study:  the article and my commentary can be dowloaded for free for the next month by clicking here!

Danish Registry study finds association of strep throat infection with increased risk for OCD and psychiatric disorders

Association of Streptococcal Throat Infection With Mental Disorders
Testing Key Aspects of the PANDAS Hypothesis in a Nationwide Study

Sonja Orlovska, MD; Claus Høstrup Vestergaard, MSc; Bodil Hammer Bech, PhD; Merete Nordentoft, DrMedSc; Mogens Vestergaard, PhD; Michael Eriksen Benros, PhD

JAMA Psychiatry. 2017;74(7):740-746. doi:10.1001/jamapsychiatry.2017.0995

In the July 2017 issue of the JAMA Psychiatry, researchers reported results from a study of over 1 million children and adolescents followed in the national registry of Denmark, and followed up to 17 years.  They found the approximately 60% of children who had streptococcal testing at some point.  Those who tested positive were more likely to have developed OCD or a tic disorder, than those without a strep test.  At a slightly lower level, they were also at increased risk for any psychiatric disorder.  Even those youth with a non-streptococcal throat infection were more likely to develop these disorders, but not as likely as those with strep positive tests.   These results support the presence of PANDAS internationally, and also potentially support the existence of PANS in Denmark. This study also adds to the voluminous useful data obtained from Scandanavian registries.