PANDAS, PANS,
Co-infections, &
Toxin Loads

Psychiatry and medication management located in Sioux Falls, Yankton, and Rapid City, South Dakota. Telehealth available in Washington, Minnesota, Nebraska, Iowa, and Wisconsin

At Elevate Minds Psychiatry, we provide psychiatric evaluation and treatment support for children and adolescents with suspected PANS or PANDAS, with a focus on mild to moderate presentations of these conditions. We will also support severe presentations, however, please keep in mind that those normally require a multi-disiplinary approach, and we will help to connect you to other modalities if needed.

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions in which a child experiences sudden onset of neuropsychiatric symptoms, often including obsessive-compulsive behaviors, tics, anxiety, mood changes, or behavioral regression. These symptoms are thought to occur when the immune system responds to infections or other triggers and unintentionally affects parts of the brain involved in behavior and emotion regulation.

Many families first notice a dramatic change in their child, sometimes seemingly overnight. Symptoms may include:
-Sudden onset OCD or intrusive thoughts
-Motor or vocal tics
-Severe anxiety or separation anxiety
-Emotional lability or irritability
-Behavioral regression or decline in school performance
-Sleep disturbances or urinary symptoms
-Sensory sensitivities or eating restrictions

Because symptoms can appear abruptly and fluctuate over time, evaluation requires a careful and comprehensive clinical approach.

PANS and PANDAS are clinical diagnoses, meaning there is no single laboratory test that confirms them. Instead, diagnosis is based on medical history, symptom patterns, and evaluation of potential triggers.

At Elevate Minds Psychiatry, our evaluation focuses on identifying factors that may be contributing to neuroinflammation or immune activation.

This may include:

Comprehensive Clinical Assessment and Labs:
We review the child’s developmental history, psychiatric symptoms, infection history, and pattern of symptom onset or flare-ups. To help identify potential triggers and co-infections associated with PANS/PANDAS, a more comprehensive set of laboratory tests is often needed. These labs allow us to evaluate underlying infections, immune responses, and contributing factors that may not be identified through standard testing alone. While some of these tests may be partially covered by insurance, others may involve out-of-pocket costs depending on your specific plan. We always aim to be thoughtful and transparent in our recommendations, focusing on the most clinically relevant testing to support your child’s care.

Screening for Infectious Triggers:
PANDAS is associated with Group A streptococcal infections, but PANS may be triggered by a variety of infections. Evaluation may include consideration of infections such as:
-Streptococcal infections
-Mycoplasma
-Viral illnesses
-Other infectious triggers

Clinical guidelines recommend evaluating for infectious causes and treating them when identified, as infections may trigger or worsen symptoms.

Evaluating Co-Infections:
In some cases, multiple infectious triggers may be present simultaneously. Identifying and addressing these factors can be an important step in stabilizing symptoms.

Assessing Inflammatory and Environmental Contributors:
In addition to infections, immune activation can be influenced by environmental factors and toxin exposure. In certain cases, clinicians may explore whether elevated toxin burden or inflammatory stressors may be contributing to symptom flares.

Our role is to support children and families through psychiatric stabilization and symptom management, particularly in mild to moderate cases.

Treatment may include:
Psychiatric evaluation and medication management when appropriate
Support for anxiety, OCD, mood symptoms, or behavioral dysregulation
Coordination with pediatricians or other medical providers
Guidance on identifying symptom triggers and patterns
Monitoring symptom progression and treatment response
Treatment for PANS/PANDAS often involves addressing underlying infections, managing inflammation, and supporting mental health symptoms simultaneously.

Every child’s presentation is different, and treatment plans are individualized.

At Elevate Minds Psychiatry, we work with children and families across a range of PANS and PANDAS presentations, from mild to more complex cases. Many children experience symptoms that, while disruptive, can be effectively supported through coordinated outpatient psychiatric care, including medication management, symptom monitoring, and collaboration with other providers.

Some children, however, develop more severe or complex presentations that may include significant functional impairment, intense OCD or behavioral dysregulation, neurologic symptoms, or medical complications requiring advanced immunologic or specialty interventions. These cases often benefit from a more intensive, multidisciplinary approach involving providers such as neurology, immunology, and infectious disease specialists.

No matter where your child falls on this spectrum, you are not expected to navigate it alone. We work alongside families to help guide next steps, coordinate care when needed, and ensure that each child is supported with the level of care that best fits their needs. Our focus is always on helping your child feel more stable, understood, and supported throughout the process.

PANS and PANDAS can be overwhelming for families, particularly when symptoms appear suddenly or fluctuate over time. Our goal is to provide thoughtful evaluation, compassionate psychiatric care, and collaborative coordination with other medical providers involved in your child’s care.

If you suspect your child may be experiencing symptoms consistent with PANS or PANDAS, we encourage you to schedule a psychiatric evaluation so we can help determine the next steps.

Concerned Your Child May Have PANS or PANDAS?

If your child has experienced sudden behavioral or emotional changes, obsessive-compulsive symptoms, or tics following an illness, a psychiatric evaluation can help determine the next steps.

Our team at Elevate Minds Psychiatry provides compassionate, thoughtful evaluations to help families better understand what may be contributing to their child’s symptoms.

PANS / PANDAS Evaluation and Treatment

Treatment at Elevate Minds Psychiatry

Mild, Moderate, and Severe Cases

Supporting Families Through a Complex Condition

Our Approach to PANS / PANDAS Evaluation

→ Schedule an appointment 

FREQUENTLY ASKED QUESTIONS

What is PANDAS?

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a clinical diagnosis describing the sudden onset of obsessive-compulsive symptoms (OCD) and/or tics following a streptococcal infection (such as strep throat).

The key features include:
-Abrupt, dramatic onset of symptoms
-OCD and/or motor or vocal tics
-Association with a recent streptococcal infection
-Episodic symptom severity (flares)

PANDAS is considered a subset of a broader condition called PANS.

What is PANS?

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a broader clinical diagnosis characterized by the sudden onset of OCD or severe eating restriction, along with at least two additional acute neuropsychiatric symptoms such as:
-Anxiety
-Emotional lability or depression
-Irritability or aggression
-Behavioral regression
-Decline in school performance
-Sensory or motor abnormalities
-Sleep disturbances
-Urinary frequency

Unlike PANDAS, PANS does not require a confirmed streptococcal trigger. Various infectious, inflammatory, or environmental factors may be involved.

How Are PANS and PANDAS Different From Typical OCD or Anxiety?

The distinguishing feature is acute onset.

Traditional psychiatric conditions typically develop gradually over time. PANS/PANDAS symptoms often appear suddenly—sometimes “overnight”—and may follow an infection or immune trigger.
Because of this pattern, evaluation may include both psychiatric and medical assessment.

What Are Co-Infections?

In the context of PANS/PANDAS, co-infections refer to additional infections that may coexist with or contribute to immune activation. These can include:
-Mycoplasma pneumoniae
-Lyme disease and tick-borne infections
-Influenza or viral illnesses
-Epstein-Barr virus
-Other bacterial or viral infections

Not every child with PANS has a co-infection, and testing decisions should be guided by clinical presentation and medical history.

How Do Infections Affect Behavior?

Infections activate the immune system. In some children, this immune activation may influence brain function, particularly in areas involved in mood, behavior, and movement regulation.

Research suggests that inflammation or immune dysregulation may temporarily alter neurotransmitter signaling and neural circuits, contributing to behavioral changes.

This does not mean the symptoms are “all medical” or “all psychiatric.” PANS/PANDAS sits at the intersection of both.

What Is Meant by “Toxin Load”?

“Toxin load” is a non-technical term sometimes used to describe environmental exposures that may contribute to overall physiological stress or inflammation. This may include:
-Mold exposure
-Heavy metals
-Air pollution
-Certain chemicals
-Chronic inflammatory stressors

The scientific evidence linking environmental toxins directly to PANS is still emerging and varies in strength. In some cases, clinicians may consider environmental history if symptoms are persistent or atypical.

Evaluation should always be individualized and evidence-informed.

Should All Children With PANS Be Tested for Mold or Toxins?

Not automatically.

Testing decisions should be based on:
-Clinical history
-Exposure risk
-Symptom pattern
-Response to standard treatment

Routine broad toxin panels without clinical indication are not universally recommended and can sometimes create confusion or unnecessary expense.

What Treatments Are Used for PANS/PANDAS?

Treatment is individualized and may include:
-Antibiotics (when bacterial infection is confirmed or strongly suspected)
-Anti-inflammatory treatments (such as NSAIDs or steroids in select cases)
-Immunomodulatory therapies (such as IVIG in moderate to severe cases)
-Cognitive Behavioral Therapy (especially ERP for OCD)
-Psychiatric medication when indicated
-Supportive school accommodations

The goal is to address both the immune component and the neuropsychiatric symptoms.

Can Stress Trigger Flares?

Yes. Psychological or physical stress can influence immune regulation and may exacerbate symptoms in some children. While stress does not cause PANS, it can amplify symptom severity.

Supporting sleep, reducing overload during flares, and maintaining structure can be helpful.

Is PANS/PANDAS Controversial?

Awareness and research continue to evolve. While early discussions were debated, increasing research supports immune-related mechanisms in at least a subset of children.

That said, evaluation requires careful clinical judgment to distinguish PANS from other psychiatric, neurological, or medical conditions.

Will My Child Recover?

Many children improve significantly with appropriate intervention. Recovery may not always be linear and can include periods of flare and remission.

Early recognition, coordinated care, and family support are important factors in long-term outcomes.

How Does Elevate Minds Psychiatry Approach PANS/PANDAS?

We approach PANS/PANDAS through a collaborative, integrative lens:
-Careful psychiatric evaluation
-Coordination with pediatricians and specialists
-Evidence-informed treatment planning
-Medication management when appropriate
-Ongoing monitoring and adjustment
-Family education and support

Our goal is not just symptom reduction—but restoring function, stability, and quality of life.

Important Disclaimer

Information provided here is for educational purposes only and does not replace individualized medical evaluation. If you suspect PANS or PANDAS, consult a healthcare professional for assessment and treatment guidance.

PANDAS Network
Provides educational resources, research summaries, and community information for families.
Website: https://pandasnetwork.org

PANDAS Physicians Network (PPN)
Provides evidence-informed clinical resources for healthcare providers and families, including diagnostic criteria and treatment guidelines.
Website: https://www.pandasppn.org

National Institute of Mental Health (NIMH)
Offers background information on PANDAS and related neuropsychiatric research.
Website: https://www.nimh.nih.gov

ASPIRE (Alliance to Solve PANS & Immune-Related Encephalopathies)
A nonprofit organization providing education, advocacy, and support for families affected by PANS and related immune-mediated encephalopathies.
Website: https://aspire.care

International OCD Foundation (IOCDF)
Provides education on OCD and related disorders, including resources on PANS/PANDAS-related OCD presentations.
Website: https://iocdf.org

PubMed (National Library of Medicine)
Searchable database of peer-reviewed research articles on PANS, PANDAS, immune-mediated neuropsychiatric disorders, and related topics.
Website: https://pubmed.ncbi.nlm.nih.gov
Search Terms to Try: “PANS treatment guidelines”, “PANDAS autoimmune neuropsychiatric”, “Basal ganglia inflammation OCD”

The Alex Manfull Fund
To deliver on Alex’s wishes and to ensure no other person loses his or her life, or lose the years it can take to treat this disease successfully, her parents established a fund in her name to raise funds to support research, provide education, and raise awareness on PANDAS and PANS.
Website: https://thealexmanfullfund.org/

Stanford PANS Clinic
Stanford University has contributed to clinical research and evaluation of PANS.
Website: https://med.stanford.edu

Latitudes (ACN Latitudes)
Educational articles on immune-related neuropsychiatric conditions.
Website: https://latitudes.org

Calm Pathways App
Track symptoms, discover patterns, and take control of your child's health. A platform that helps you understand their condition and make informed decisions.
Website: https://meandmypandas.com/

Understood.org
Information on school accommodations (504 Plans and IEPs) that may support children experiencing neuropsychiatric symptoms.
Website: https://www.understood.org

Because PANS/PANDAS can be complex and emotionally charged, we encourage families to:
-Seek peer-reviewed, evidence-informed sources
-Be cautious of claims promising rapid cures
-Consult qualified healthcare professionals before beginning new treatments
-Verify laboratory testing and treatment recommendations through licensed providers

At Elevate Minds Psychiatry, we support families in navigating PANS and PANDAS with evidence-informed care, collaborative planning, and compassionate guidance. We are happy to help interpret research, coordinate with specialists, and support both psychiatric and medical aspects of care.

Some resources listed on this page are developed or owned by providers affiliated with Elevate Minds Psychiatry.

Navigating PANS and PANDAS can feel overwhelming. The following organizations and educational resources provide research updates, clinical guidance, advocacy support, and community education for families and providers.

National & International Organizations

Research & Clinical Information

Educational & Family Support

School & Advocacy Resources

When Reviewing Online Information

Our Commitment

External Resources for PANDAS & PANS

Google Apple

Take the Next Step Toward Clarity and Support

If you or your child are experiencing changes in mood, behavior, focus, or emotional well-being, a comprehensive iNtake evaluation can help identify what may be contributing and guide the next steps in care.

At Elevate Minds Psychiatry, we take a thoughtful, personalized approach to mental health care. Our team works with individuals and families to better understand symptoms, explore treatment options, and develop a plan that supports long-term wellness.

You may also find these resources helpful as you explore your next steps:

Intake appointments

Medication Management

Anxiety Disorders

Obsessive Compulsive Disorder (OCD)

ADHD Evaluations

→ Schedule an intake appointment

PANDAS, PANS, Co-infections, &Toxin Loads