Objective To explore associated clinical factors in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). Study design Children with tics and/or OCD (n = 109) were examined by personal and family history, diagnostic interview, physical examination, medical record review, and measurement of baseline levels of streptococcal antibodies. Results Significant group differences were found on several variables, such that those diagnosed with PANDAS (versus without PANDAS) were more likely to have had dramatic onset; definite remissions; remission of neuropsychiatric symptoms during antibiotic therapy; a history of tonsillectomies/adenoidectomies; evidence of GAS infection, and clumsiness. Conclusion The identification of clinical features associated with PANDAS should assist in delineating risks for this subtype of OCD/tics.

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Characterized by multiple motor and phonic tics, Tourette syndrome (TS) is also associated with a constellation of comorbid disorders, including obsessive-compulsive symptoms that occur in 40-60 % of patients. The pathophysiology of tics has been linked by many studies to specific cortical and basal ganglia changes and hypothesized to relate to dysregulation of dopamine responsive/dependent circuits (Jordan et al., 2004). Aripiprazole, a recently released atypical antipsychotic noted for its partial D 2 agonist activity along with a low propensity for extrapyramidal effects, has been shown to be efficacious in reducing symptoms of schizophrenia in adults. The value of aripiprazole for treating neuropsychiatric disorders in children has not previously been reported. We present results of a retrospective chart review of six youth with TS and comorbid obsessivecompulsive disorder (OCD) who were treated for 12 wk with aripiprazole.All subjects were previously enrolled in an observational study at the University of Florida. Assessment instruments were given at 6-wk intervals to measure symptom severity in the areas of tics (YGTSS : Yale Global Tic Severity Scale; Leckman et al., 1989) and obsessions and compulsions (C-YBOCS : Children's Yale-Brown Obsessive Compulsive Scale ; Goodman et al., 1989). Subject information was also gathered on medication history, adverse effects and any illness diagnosed since their previous visit. While participating in this observational study, coincidentally, six subjects were placed on aripiprazole by their clinical physicians for treatment of tics. After receiving IRB approval, we did a retrospective chart review on these six subjects to determine if the aripiprazole had any effect on their symptom severity. There were four children and two adolescents (3 males, 3 females) ranging in age from 8 to 19 yr (average age 12.1¡4.05 yr). All of the subjects had TS with OCD. Four of the six subjects had received multiple previous medication trials with limited efficacy and were on one or more psychotropic medications.We reviewed charts from the observational study for scores on the assessment instruments listed above, along with weight, blood pressure, medication dose and adverse effects for the observational study visits coinciding with the pre-aripiprazole, and 12-wk post-aripiprazole time-period. The average prearipiprazole tic severity score on the YGTSS was 31.2 (8.3) with a range of 22-38 (instrument range 0-50) and pre-aripiprazole OCD severity score on the C-YBOCS was 28.2 (4.1) with a range of 22-34 (instrument range 0-40). The average dose of aripiprazole taken was 11.7 mg (range 5-20 mg) or 0.21 mg/kg (range 0.08-0.6 mg/kg). After 12 wk of treatment, the average tic severity score on the YGTSS was 13.7 (4.4) with a range of 8-18, a decrease of 56 %. The average OCD severity score on the C-YBOCS after 12 wk of treatment was 8.2 (5.5) with a range of 0-16, a decrease of 71 %. As noted in the charts, three subjects reported mild and transient adverse effects. One reported teeth chatt...

In this preliminary open-label trial, aripiprazole was a well-tolerated treatment for tics and co-morbid OCD and ADHD symptoms. Improvements in co-morbid conditions may be secondary to tic reduction or to specific to aripiprazole therapy; however, further study is warranted.