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Met a kid with this my first pediatric clerkship in med school. I was told it was super rare and then had to memorize a bunch more stuff and forgot all the deta

Met a kid with this my first pediatric clerkship in med school. I was told it was super rare and then had to memorize a bunch more stuff and forgot all the details about the visit. Always wish I could remember that patient better

derbOac 3y ago
I've seen multiple cases like this professionally, and they don't always have the typical PANDAS profile, either in terms of sequelae or putative causes. Kid gets illness, very clear signs (very high temperature for example), sometimes admitted, dramatic personality change afterward. The cases I remember most were around 7-12 but I recall one that was more around the age of 17. It was unnerving for multiple reasons the first time I worked on these types of cases; one of those types of experiences that made me realize there's a fair amount of very serious illness out there that "goes under the radar" in the sense that there's serious consequences and little to no way to prevent it and poor understanding afterward of exactly what happened.
s0kr8s 3y ago
These cases aren't nearly as rare as the medical system would have you believe. Go to a residential psych hospital for kids, or a day treatment program for level 3 or 4 EBD children, and you'll see a bunch of them, many of whom have been languishing there for years. These kids are are more of an ugly and inconvenient truth that the medical world would prefer to ignore, so these kids get chucked over the wall to the mental health system instead, which is better prepared to simply lock them up and quarantine them from the rest of society. For the most part, I think doctors want to work mostly with helpless and grateful children, who willingly submit to tests and follow orders, not angry, aggressive children who claw and bite you no matter what you do or say. If you don't "behave" then medicine doesn't want you. Go see a shrink. This is part of why I hate the term "behavioral health," because the emphasis is on restoring compliance. There was a movement in the 90's to rebrand "mental health" as "behavioral health" in order to make it seem more reputable and science-y, but I think that move back-fired. I think we delivered more compassionate care when the emphasis was on trying to some notion of a person's healthy subjective mental state, rather than trying to get them to behave.

derbOac 3y ago

I've seen multiple cases like this professionally, and they don't always have the typical PANDAS profile, either in terms of sequelae or putative causes. Kid gets illness, very clear signs (very high temperature for example), sometimes admitted, dramatic personality change afterward. The cases I remember most were around 7-12 but I recall one that was more around the age of 17. It was unnerving for multiple reasons the first time I worked on these types of cases; one of those types of experiences that made me realize there's a fair amount of very serious illness out there that "goes under the radar" in the sense that there's serious consequences and little to no way to prevent it and poor understanding afterward of exactly what happened.

s0kr8s 3y ago

These cases aren't nearly as rare as the medical system would have you believe. Go to a residential psych hospital for kids, or a day treatment program for level 3 or 4 EBD children, and you'll see a bunch of them, many of whom have been languishing there for years. These kids are are more of an ugly and inconvenient truth that the medical world would prefer to ignore, so these kids get chucked over the wall to the mental health system instead, which is better prepared to simply lock them up and quarantine them from the rest of society. For the most part, I think doctors want to work mostly with helpless and grateful children, who willingly submit to tests and follow orders, not angry, aggressive children who claw and bite you no matter what you do or say. If you don't "behave" then medicine doesn't want you. Go see a shrink. This is part of why I hate the term "behavioral health," because the emphasis is on restoring compliance. There was a movement in the 90's to rebrand "mental health" as "behavioral health" in order to make it seem more reputable and science-y, but I think that move back-fired. I think we delivered more compassionate care when the emphasis was on trying to some notion of a person's healthy subjective mental state, rather than trying to get them to behave.