Abstract
This issue of the journal is remarkable for a series of articles from a group providing context and tools for clinical assessment of aggressive symptoms.
Connor et al. provide a thorough review of the literature around symptoms of aggression in pediatric psychiatric disorders, including a historical summary of psychological constructs and neurobiological correlates. They propose a subset of aggression—so-called impulsive aggression, or IA—which the authors suggest is the most common form seen in clinical settings and an obvious target of treatment. In addition to a helpful, if brief, review of psychosocial prevention and intervention programs for aggression, the authors expand upon pharmacological treatments including some in development, SPN-810, a new formulation of the antipsychotic molindone (Moban).
Elsewhere, in articles from Ceresoli-Borroni et al., researchers from the same group present a description and validation of the “IA diary,” a psychometric tool for assessment of impulsive aggression in youth aged 6–12 years with attention-deficit/hyperactivity disorder.
This issue also contains several intriguing articles focused on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS), pediatric acute neuropsychiatric syndrome (PANS), and other immune-related issues in obsessive-compulsive disorder (OCD).
Lepri et al. describe a chart review of 371 Italian children with PANDAS or PANS. The authors present noteworthy findings on the diagnostic relevance of serological characterization. “Among PANDAS cases,” they write, “a clear streptococcal infection was clinically evident at the onset of neurological symptoms in only 74 patients (21.4%), whereas the relationship with Streptococcus pyogenes was confirmed by serologic tests in the other 271 (78.6%).”
Lepri et al. provide a clear description of the value of antibiotic treatment and prophylaxis. “All PANDAS/PANS patients received prophylaxis with benzathine benzylpenicillin,” they write, with the result that 75% of PANDAS patients and 88.4% of PANS patients show improvement within a matter of months.
In a fascinating article, Westwell-Roper et al. describe results of a large-scale survey of patients with a history of OCD before age 18 years and their relatives as a part of the OCD Collaborative Genetics Association Study. “These data suggest high rates of streptococcal-related and other immune-mediated diseases in patients with childhood-onset OCD,” the authors write, “and are consistent with epidemiological studies in adults noting familial clustering.”
Finally, Hesselmark and Bejerot compare patient responses with different PANS/PANDAS treatments (including antibiotics, cognitive behavioral therapy, selective serotonin reuptake inhibitors, and intravenous immunoglobulin) in a Swedish population.