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Sudden and severe onset of obsessive-compulsive disorder (OCD) may present secondary to infectious and/or immune-mediated triggers. We assessed the preliminary efficacy, tolerability, and safety of azithromycin compared with placebo in the treatment of OCD and associated symptoms in children with pediatric acute-onset neuropsychiatric syndrome (PANS).

Crystal Henry always thought her daughter Violet was a happy kid-she’d even avoided the terrible twos. But everything changed when the 5-year-old began experiencing constant mood swings and bed-wetting incidents.

“It wasn’t just a phase,” Crystal said. “Violet continued to behave erratically, with extreme mood swings. She also started to exhibit verbal and physical tics, which she had never done before.”

At 7 years old, Paul Michael Nelson was the kind of quiet, brilliant kid you were likely to find in Silicon Valley — captivated by Legos, self-taught in origami, loving and sweet. But on March 2, 2009, he woke up in the middle of the night, monstrously changed. He tore up the flooring in his bedroom. He got hold of a knife and stabbed holes through his door. He began speaking a strange language no one could understand. He tried pulling his teeth out. He barked like a dog.