Value-Based Management of Pediatric Acute-Onset OCD: A Case Consistent With Possible Pediatric Acute-Onset Neuropsychiatric Syndrome

This case highlighted a value-based approach to abrupt-onset obsessive-compulsive disorder (OCD) consistent with a possible pediatric acute-onset neuropsychiatric syndrome (PANS) presentation, where timely intervention facilitated recovery while avoiding unnecessary and costly levels of care. The authors have described a 14-year-old male who developed sudden, severe OCD symptoms following influenza A infection. His presentation included functional decline, poor insight, and complex family dynamics. Traditional pediatric OCD was considered but deemed less likely due to the abrupt onset, absence of family history, and persistence of symptoms postinfection. Minimal treatment engagement and refusal of medication necessitated an extended involuntary hold and court-approved pharmacotherapy due to illness severity and medical complications. With initiation of fluoxetine during inpatient treatment, the patient stabilized and transitioned to intensive outpatient therapy. This case underscored the importance of recognizing PANS as a potential diagnostic framework, ensuring appropriate evaluation of underlying causes, and implementing timely, decisive treatment. As antibody testing, including central nervous system and cerebrospinal fluid autoantibody testing, were not obtained, the diagnostic certainty was best characterized as a possible PANS presentation. Lastly, this case illustrated a value-based care model, emphasizing efficient diagnostic testing, judicious use of higher levels of care, and coordinated transitions that reduced cost without compromising outcomes.