Neither<unk>  nor PANS are listed as a diagnosis in the 2013 fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) or confirmed as distinct disorders.<unk>  is mentioned in the World Health Organization's ICD-11, effective in 2022, under autoimmune central nervous system disorders, but diagnostic criteria are not defined and no specific code for PANS or<unk>  is given. The 2021 European clinical guidelines developed by the European Society for the Study of Tourette syndrome (ESSTS) did not support the additions made to ICD-11. Swedo et al in their 1998 paper proposed five diagnostic criteria for<unk> . According to Lombroso and Scahill (2008), those criteria were: "(1) the presence of a tic disorder and/or OCD consistent with DSM-IV; (2) prepubertal onset of neuropsychiatric symptoms; (3) a history of a sudden onset of symptoms and/or an episodic course with abrupt symptom exacerbation interspersed with periods of partial or complete remission; (4) evidence of a temporal association between onset or exacerbation of symptoms and a prior streptococcal infection; and (5) adventitious movements (e.g., motoric hyperactivity and choreiform movements) during symptom exacerbation". The proposed PANS criteria call for abrupt onset of OCD (severe enough to warrant a DSM diagnosis) or restricted food intake, along with severe and acute neuropsychiatric symptoms from at least two of the following: anxiety, emotional lability or depression, irritability or oppositional behaviors, developmental regression, academic deterioration, sensory or motor difficulties, or sleep or urinary disturbances. The symptoms should not be better explained by another disorder, such as Syndenham chorea or Tourette syndrome. The authors stated that all other causes must be excluded (diagnosis of exclusion) for PANS to be considered. There is no diagnostic test to accurately confirm<unk> . The diagnostic criteria of all the proposed conditions<unk> , PITANDs, CANS and PANS) are based on symptoms and presentation, rather than on signs of autoimmunity. A commercial tool known as the "Cunningham Panel" and marketed by Moleculera Labs—intended to diagnose<unk>  and PANS based on assays of antibodies—did not distinguish between children with and without PANS when independently tested.<unk>  may be overdiagnosed: the diagnostic criteria are unevenly applied and a presumed diagnosis may be conferred in "children in whom immune-mediated symptoms are unlikely", according to Wilbur et al (2019). Most patients diagnosed with<unk>  by community physicians did not meet the criteria when examined by specialists, suggesting the<unk>  diagnosis is conferred by community physicians without conclusive evidence. Because symptoms overlap with many other psychiatric conditions, differential diagnosis is challenging. There are several difficulties in distinguishing<unk>  from TS. The two have a similar onset and waxing and waning course, and the sudden onset or exacerbation in tics hypothesized in<unk>  is not uncommon in TS. There is a higher rate of OCD and TS among relatives of children with<unk> , and those children often have tics preceding a<unk>  diagnosis or may be predisposed to tic disorders; what appears to be a dramatic onset due to GAS infection "may be the natural course of tic disorders", according to Ueda and Black (2021).
PANDAS
DRACO
THIRRA
SCAN
OCRL
OHVIRA
DEBRA
CoWIN