Sudden Onset Disordered Eating Behaviors and Appetite Issues in a Local Clinical Cohort of Children With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

IF 4.3 2区医学 Q1 NUTRITION & DIETETICS International Journal of Eating Disorders Pub Date : 2025-03-31 DOI:10.1002/eat.24388

Cynthia Kapphahn, Brianna Peet, Jaynelle Gao, Avis Chan, Bahare Farhadian, Meiqian Ma, Melissa Silverman, Paula Tran, Noelle Schlenk, Margo Thienemann, Jennifer Frankovich

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Abstract

Objective

Abrupt onset restrictive food intake can be a cardinal symptom of pediatric acute-onset neuropsychiatric syndrome (PANS). However, few reports detail eating restriction patterns and baseline eating behaviors in patients with PANS, which we aim to address. Additionally, we aim to compare PANS eating restriction with ARFID.

Methods

Retrospective chart review of 130 patients with PANS, aged 4–18 years, presenting for initial assessment at Stanford's PANS/Immune Behavioral Health (IBH) Clinic. Data were abstracted from electronic medical records (EMR) and parent/child questionnaires which included symptom ratings and psychometric scores. Baseline eating restriction and abrupt onset changes in eating associated with PANS flares were studied.

Results

Over half (56%) of the PANS patients developed abrupt-onset restricted food intake during flare prompting clinic entry. Of youth with restricted intake, 48% had selective eating, 41% had low appetite/interest in food, 37% feared aversive consequences (26% swallowing/choking/vomiting concerns, 16% feared contamination), and 4% overweight concerns. Youth with restricted intake had high levels of emotional lability and/or depression (96%), irritability, aggression, or oppositional behaviors (89%), behavioral/developmental regression (60%), cognitive impairment (69%), and sensory amplification (64%). Baseline eating restriction was noted in 16 (12%), with 9 altering eating behaviors during flare.

Conclusions

Eating restriction is common during PANS flares, reasons align with 3 main presentations of ARFID: Selective eating, low appetite/interest, and fear of aversive consequences. High levels of other neuropsychiatric symptoms are noted in youth with PANS and eating restriction during flares. Twelve percent of PANS patients have baseline eating restriction; over half of whom alter eating behaviors during the flare.

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小儿急性发作性神经精神综合征（PANS）患儿当地临床队列中的突发性饮食行为失调和食欲问题

目的：突然开始限制食物摄入可能是小儿急性神经精神综合征（PANS）的一个主要症状。然而，有关 PANS 患者进食限制模式和基线进食行为的详细报道很少，我们旨在解决这一问题。此外，我们还希望将 PANS 饮食限制与 ARFID 进行比较：对在斯坦福大学 PANS/免疫行为健康（IBH）诊所接受初步评估的 130 名 4-18 岁 PANS 患者进行回顾性病历审查。数据摘自电子病历（EMR）和家长/儿童问卷，其中包括症状评级和心理测量评分。研究了与 PANS 复发相关的基线饮食限制和突然发生的饮食变化：半数以上（56%）的 PANS 患者在病情发作时突然出现进食受限的情况，并因此进入诊所就诊。在进食受限的青少年中，48%有选择性进食，41%食欲不振/对食物不感兴趣，37%担心厌恶性后果（26%担心吞咽/呕吐/呕吐，16%担心污染），4%担心超重。进食受限的青少年中，情绪不稳定和/或抑郁（96%）、易怒、攻击或对抗行为（89%）、行为/发育倒退（60%）、认知障碍（69%）和感官放大（64%）的比例较高。16例（12%）患者有饮食限制的基线，其中9例在病情发作期间改变了饮食行为：结论：在 PANS 病发期间限制进食很常见，其原因与 ARFID 的 3 个主要表现一致：选择性进食、食欲/兴趣低下和害怕厌恶性后果。在患有 PANS 并在病情发作时限制饮食的青少年中，其他神经精神症状的发病率也很高。12% 的 PANS 患者有基线进食限制；其中一半以上的患者在病情发作时会改变进食行为。

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来源期刊

International Journal of Eating Disorders 医学-精神病学

CiteScore

10.00

自引率

12.70%

发文量

204

审稿时长

4-8 weeks

期刊介绍： Articles featured in the journal describe state-of-the-art scientific research on theory, methodology, etiology, clinical practice, and policy related to eating disorders, as well as contributions that facilitate scholarly critique and discussion of science and practice in the field. Theoretical and empirical work on obesity or healthy eating falls within the journal’s scope inasmuch as it facilitates the advancement of efforts to describe and understand, prevent, or treat eating disorders. IJED welcomes submissions from all regions of the world and representing all levels of inquiry (including basic science, clinical trials, implementation research, and dissemination studies), and across a full range of scientific methods, disciplines, and approaches.