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F Is for Family
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F Is for Family
F Is for Family promotional poster
Genre
Animated sitcom
Comedy-drama
Created by
Bill Burr
Michael Price
Starring
Bill Burr
Laura Dern
Justin Long
Debi Derryberry
Haley Reinhart
Sam Rockwell
Opening theme
"Come and Get Your Love" by Redbone
Country of origin
United States
Original language(s)
English
No. of seasons
2
No. of episodes
16 (list of episodes)
Production
Executive producer(s)
Vince Vaughn
Peter Billingsley
Bill Burr
Michael Price
Katie O'Connell
Elisa Todd Ellis
Sidonie Dumas
Christophe Riandee
Producer(s)
Heath Kenny
Brian J. Cowan
Running time
25–28 minutes
Production company(s)
Wild West Television
Loner Productions
King of France Productions
Gaumont International Television
Gaumont Animation
Telegael Teoranta
Distributor
Netflix
Release
Original network
Netflix
Original release
December 18, 2015 – present
External links
Website
www.netflix.com/title/80028732
F Is for Family is an American web animated sitcom[1] created by Bill Burr and Michael Price [2] and produced by Gaumont International Television and Vince Vaughn's Wild West Television.[2]
The show premiered on December 18, 2015 to generally favorable reviews.[3] Season 2 premiered May 30, 2017.[4] On June 28, 2017, the show was renewed for a third season.[5]
Contents
[hide]
1 Cast
1.1 Main
1.2 Co-starring
1.3 Recurring
2 Episodes
2.1 Season 1 (2015)
2.2 Season 2 (2017)
3 Production
4 Reception
5 Awards and nominations
6 References
7 External links
Cast[edit]
Main[edit]
Bill Burr as Francis X. "Frank" Murphy – Frank is a disillusioned, short-tempered, Irish-American, Korean War veteran and father of three who lives in a Great Lakes region town in 1973. He is prone to angry, profane rants. As a parent, Frank often responds to his children with threatening language and emotional abuse. The Murphy children often go out of their way to avoid upsetting their father. Frank works as a baggage handler at the local Mohican Airlines, and is promoted to management after his boss dies in a violent workplace accident. Frank is usually seen spending many hours in front of his television set while at home. Frank's favorite show is an action series called Colt Luger. Luger, an overweight middle-aged character who is portrayed as an unerringly victorious hero. When facing dire situations, Luger utters the phrase "Sometimes, a man's got to do...what a man does", much to Frank's excitement.
Laura Dern as Sue Murphy[2] – Frank's wife who is a housewife, and also sells Plast-a-Ware (a play on words of Tupperware.)
Justin Long as Kevin Murphy[1][2] – Kevin is Frank's teenage son, who is a bit of a juvenile delinquent. Despite his rebellious personality, Kevin often shows signs of love and respect for his parents and a desire to better himself (although he rarely, if ever, follows through on the latter).
Debi Derryberry as Maureen Murphy [2][6] – Maureen is Frank's young daughter who he often refers to as "Princess". However, even though Frank sees Maureen as a princess, Maureen is an intelligent child and can be destructive like the rest of her family members. However, Maureen is smart enough to hide it.
Haley Reinhart as Bill Murphy, Frank's younger son.[7][8] Bill tends to be shy and is skinny. He gets bullied frequently. He is 11 years old in the first season.[9]
Sam Rockwell as Vic – Frank's wealthy, womanizing neighbor, who brags a lot. Frank loathes him for his playboy lifestyle, cheerful attitude, and successful career.
Co-starring[edit]
Mo Collins as Jimmy, Vivian, Ben, Brandy, Ginny[10]
Trevor Devall as Red, Bolo, Mr. Goomer, others[11][12]
Phil Hendrie as Jim Jeffords, Colt Luger, others[13][14]
Recurring[edit]
Kevin Michael Richardson as Rosie, others
David Koechner as Robert "Bob Pogo" Pogrohvich, Frank's obese, chainsmoking boss.[15][16]
Kevin Farley as Babe, Carl, others[17]
Gary Cole as Rodger Dunbarton, the owner and founder of the airlines where Frank and his co-workers work.
Joe Buck as Lou Gagliardi, others[18]
John DiMaggio as Scoop Dunbarton
Allison Janney as Henrietta Van Horne[19]
T.J. Miller as Randy
Michael K. Williams as Smoky
Episodes[edit]
Season
Episodes
Originally released
1 6 December 18, 2015 (2015-12-18)
2 10 May 30, 2017 (2017-05-30)
Season 1 (2015)[edit]
No.
overall
No. in
season
Title
Directed by
Written by
Original release date
Prod.
code
1
1 "The Bleedin' in Sweden" Benjamin Marsaud Story by : Bill Burr and Michael Price
Teleplay by : Michael Price December 18, 2015 (2015-12-18) 101
Frank is excited at the prospect of having the entire neighborhood over to watch an upcoming boxing match, but when Vic threatens to ruin his chances with his much more expensive and exciting television set, Frank overpromises that he has a color TV to convince the neighbors to come to his house instead. After he purchases one, Bill accidentally ruins it when he sticks a magnet on it as part of a school project. Frank initially believes that the store sold him a lemon and has an outburst in front of all the employees and customers when they refuse to give him a refund, embarrassing Sue. Bill eventually confesses, but after being gloated over by one of the store's employees when Frank and Sue take him to apologize, Bill uses his magnet to ruin every single television set in the store, and Frank gets refunded. At the end of the episode, the neighbors watch the match at Frank's house, while Vic watches it at his house "alone".
2
2 "Saturday Bloody Saturday" Laurent Nicolas David Richardson December 18, 2015 (2015-12-18) 102
After finding out that Kevin is failing nearly every single one of his classes, Frank takes him to his job at the airport, where he's recently been promoted after his former boss was decapitated in a violent work accident, to demonstrate to him the responsibilities of caring for a family. Frank is torn between his underpaid, hard-working co-workers who are contemplating a strike, and his employer, who worries a strike will shut down Mohican Airways for good. Although Kevin is initially unimpressed and spends most of the day hanging around with some pill-popping, underachieving airport staff, he realizes the difficulties of his father's job after he witnesses Frank being yelled at and insulted by an old woman, who accuses the airport of stealing her medication, and comes to appreciate how hard Frank works to put food on the table. Meanwhile, after his father puts him in charge of Maureen for the day, Bill struggles to keep her rebellious nature under wraps, while Sue begins to doubt her solitary role as a mother and wife.
3
3 "The Trough" Benjamin Marsaud Michael Price December 18, 2015 (2015-12-18) 103
Despite Kevin's promises to get back on track to improve his grades, Frank is outraged when he finds out that Kevin is still falling behind, and as a punishment, takes Bill to a football game where he was given corporate seats by the management at Mohican Airways, which Frank had initially promised Kevin to go to. While there, they meet Rodger Dunbarton, CEO at Mohican Airways, who speaks to Frank about talks of a strike and how he must no longer sympathize with his co-workers. On the drive home, their car breaks down, and they are rescued by Rosie, one of Frank's colleagues, but when Bill innocently reveals they had been given tickets to a football game and his father's conversation with Dunbarton, Frank faces a hostile situation at work. Meanwhile, Sue goes to the mall with Maureen, where she is accosted by a talkative friend, and Maureen learns of her mother's underwhelming home life during a surprise outburst. Kevin hangs out with friends and gets high, reminiscing of the loving relationship he and his father had when he was young.
4
4 "'F' is for Halloween" Laurent Nicolas Tom Gianas December 18, 2015 (2015-12-18) 104
On Halloween, Frank attempts to dissuade Sue from a promotion, leading to tensions between them; Bill is reluctant to trick-or-treat due to his fear of being bullied.
5
5 "Bill Murphy's Day Off" Benjamin Marsaud Emily Towers December 18, 2015 (2015-12-18) 105
Bill tries to hide his recent suspension while Frank earns the ire of his co-workers for befriending the aloof CEO of the airline. In addition, Frank struggles to make good on a promise to Kevin.
6
6 "O Holy Moly Night" Laurent Nicolas David Richardson December 18, 2015 (2015-12-18) 106
When Christmas comes near, Frank is desperate to remedy the hostility of his co-workers and his supervisors at the airport while the family dog is missing. Kevin starts his part-time job. Bill becomes an altar boy at the church and gets into trouble.
Season 2 (2017)[edit]
No.
overall
No. in
season
Title
Directed by
Written by
Original release date
Prod.
code
7
1 "Heavy Sledding" Romain Bounoure & Olivier Schramm Michael Price May 30, 2017 (2017-05-30) TBA
Three weeks after he got fired, Frank is still unemployed. On a snow day, Sue decides to take the family sledding to get them out of their slump.
8
2 "A Girl Named Sue" Romain Bounoure & Olivier Schramm David Richardson May 30, 2017 (2017-05-30) TBA
Frank's old boss, Bob Pogo, calls him to offer him a job, only for things to turn out bad for Frank. Meanwhile, Sue ponders a change in her life.
9
3 "The Liar's Club" Romain Bounoure & Olivier Schramm Bill Burr May 30, 2017 (2017-05-30) TBA
After bailing out of the unemployment office, Frank turns to Rosie's friend, Smokey, for a job, but not before helping Kevin move into the basement after he ditches school. Meanwhile, Sue gets a new job as a secretary, but is mistreated by the sexist heads of her company.
10
4 "Night Shift" Romain Bounoure & Olivier Schramm Emily Towers May 30, 2017 (2017-05-30) TBA
Frank gets a job as a stocking man courtesy of Smokey, consequently sleeping through the day and ignoring Sue and his family. All the while, Kevin and his band try to get a gig and Sue has an idea for a new Plast-a-Ware product.
11
5 "Breaking Bill" Romain Bounoure & Olivier Schramm Joe Heslinga May 30, 2017 (2017-05-30) TBA
After Frank learns that Kevin and his band are performing on a school night, his attempts at halting it cause intense tension between him and Kevin. Meanwhile, Bill, having received money from his job as a paperboy, tries to buy a hockey-stick for hockey tryouts, but a run-in with the local bully, Jimmy, pushes him over the edge. Also, when Sue pitches her idea, she still receives a lack of respect.
12
6 "This is Not Good" Romain Bounoure, Olivier Schramm & Mike Roberts Henry Gammill May 30, 2017 (2017-05-30) TBA
When Frank's new job includes a stop at the airport, he ends up in a predicament with Bob. Kevin tries to get a date with a 'haircut' girl, but due to erection problems, he bails and this attracts the attention of Vic's new girlfriend. Also, Bill begins to enjoy lifting his legs on the law, much to the concern of his friend Phillip.
13
7 "Fight Night" Romain Bounoure, Olivier Schramm & Mike Roberts Eric Goldberg & Peter Tibbals May 30, 2017 (2017-05-30) TBA
Frank and Sue's individual underhanded actions causes them to have a major fight on their anniversary when they're called into a meeting with Maureen's school teacher.
14
8 "F is for Fixing It" Romain Bounoure, Olivier Schramm & Mike Roberts Valeri Vaughn May 30, 2017 (2017-05-30) TBA
Frank and Sue try to deal with their marital problems; Kevin feels guilty for having sex with Vic's new girlfriend; and when Jimmy tried to make amends after he has been released from Catholic Military School, a fearful revelation from Phillip reveals Bill's part in sending him away, causing Jimmy to go back to his bullying ways.
15
9 "Pray Away" Romain Bounoure, Olivier Schramm & Mike Roberts Marc Wilmore May 30, 2017 (2017-05-30) TBA
Frank and Sue go to a couple's retreat to get help from a religious psychiatrist when their marriage begins to hit a snag, which only leads to a moment of truth between them. Meanwhile, Bill and his friends try to deal with a vengeful Jimmy, while Kevin is forced to deal with Vic when the latter finds out about his girlfriend's affair with Kevin.
16
10 "Landing the Plane" Romain Bounoure & Olivier Schramm Michael Price May 30, 2017 (2017-05-30) TBA
The day takes a traumatic turn for the Murphys when the founder of Plast-a-Wares takes credit for Sue's idea and Frank and his friends attempt to get rid of "Scoop," the mentally unstable new manager (and Roger Dunbarton's nephew), which inadvertently causes them to be caught in the middle of a terrorist attack caused by a Black Panthers-esque band of domestic terrorists.
Production[edit]
The series was announced in October 2014 as part of a partnership between Netflix, Gaumont International Television, and Wild West Television.[20] The show is a "family comedy" based on the standup of Bill Burr.[21] Moreover, the show takes place in the 1970s, "a time when you could smack your kid, smoke inside, and bring a gun to the airport".[21] Burr voices the Murphy family patriarch, with Laura Dern as his wife, Justin Long as his eldest son, Debi Derryberry as his daughter Maureen, and Haley Reinhart as his young son.[7][8][21] The first season consists of six episodes, shown in a serial manner, written by Bill Burr and Michael Price.[22] Price is best known for his Emmy and Writers Guild award-winning work on The Simpsons.[22] The series is co-directed by Ben Marsaud (director of Counterfeit Cat & former storyboard artist on The Amazing World of Gumball).
Reception[edit]
The series has received generally positive reviews.[23] On Rotten Tomatoes the series holds a rating of 87% based on 15 reviews, with an average score of 7.1/10. The site's critical consensus reads, "While the humor relies on vulgarity, the strength of F Is for Family is its substantial heart."[24] On Metacritic, the series holds a score of 75 out of 100, based on 14 reviews, indicating "Generally favorable reviews".[25]
Awards and nominations[edit]
Year
Award
Category
Nominee
Result
2017 69th Primetime Emmy Awards Outstanding Character Voice-Over Performance Mo Collins as Ginny, Jimmy Fitzsimmons, Lex, Ben, and Cutie Pie (Episode: Pray Away) Pending
References[edit]
^ Jump up to: a b "F is for Family: Original, Animated Series From Bill Burr Coming Exclusively to Netflix". PR Newswire. October 23, 2014. Retrieved November 23, 2014.
^ Jump up to: a b c d e "Netflix Orders ‘F Is for Family’ Animated Comedy Series from Bill Burr". Variety. October 23, 2014. Retrieved November 23, 2014.
Jump up ^ "‘F Is For Family’ Gets December Premiere On Netflix". Deadline.com. November 6, 2015. Retrieved November 7, 2015.
Jump up ^ "F Is for Family - Season 2 Date Announcement Teaser - Netflix". April 18, 2017.
Jump up ^ Otterson, Joe (2017-06-28). "‘F Is for Family’ Renewed for Season 3 at Netflix". Variety. Retrieved 2017-06-28.
Jump up ^ "That's the amazing @DebiDerryberry". Twitter.com. December 24, 2015. Retrieved December 28, 2015.
^ Jump up to: a b "'American Idol' Alum Haley Reinhart to Star in New Netflix Animated Series". Hollywood Reporter. December 12, 2014. Retrieved January 18, 2015.
^ Jump up to: a b "I will be making my VoiceOver debut...". Instagram.com. December 11, 2014. Retrieved January 18, 2015.
Jump up ^ "'F' is for Halloween". F is for Family. Season 1. Episode 4. 26 June 2017. Netflix.
Jump up ^ "Mo voices Jimmy". Twitter.com. December 19, 2015. Retrieved December 28, 2015.
Jump up ^ "#FIsForFamily cast rollcall Part 5". Twitter.com. December 14, 2015. Retrieved December 27, 2015.
Jump up ^ "I love Mr. Goomer". Twitter.com. December 26, 2015. Retrieved December 27, 2015.
Jump up ^ "#FIsForFamily cast roll call". Twitter.com. December 12, 2015. Retrieved December 27, 2015.
Jump up ^ "In Bill Burr's New Netflix Series". Decider.com. December 24, 2015. Retrieved December 28, 2015.
Jump up ^ "I play this guy". Twitter.com. December 19, 2015. Retrieved December 27, 2015.
Jump up ^ "He's so so great as Bob Pogo". Twitter.com. December 23, 2015. Retrieved January 1, 2016.
Jump up ^ "#FIsForFamily cast rollcall part 6". Twitter.com. December 15, 2015. Retrieved December 27, 2015.
Jump up ^ "Who does Joe Buck voice". Twitter.com. December 22, 2015. Retrieved December 28, 2015.
Jump up ^ Perkins, Dennis (June 11, 2017). "F Is For Family knows that all family debts come due sometime". The A.V. Club. Retrieved June 25, 2017.
Jump up ^ "Netflix Orders Bill Burr Cartoon 'F Is for Family'". Hollywood Reporter. October 23, 2014. Retrieved November 23, 2014.
^ Jump up to: a b c "Netflix orders Bill Burr animated series F Is For Family". AV Club. October 23, 2014. Retrieved November 23, 2014.
^ Jump up to: a b "‘F is for Family’ is the newest addition to Netflix’s original shows". Digital Trends. October 23, 2014. Retrieved November 23, 2014.
Jump up ^ "F is for Family || Critica animada". CoolPop: criticas animadas, noticias y rumores sobre animacion. Retrieved 2017-03-03.
Jump up ^ "F is for Family: Season 1". Rotten Tomatoes. Retrieved December 22, 2015.
Jump up ^ "F is for Family – Season 1". Metacritic. Retrieved December 22, 2015.
External links[edit]
F Is for Family on IMDb
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This article is about the hypothesized neurological disorder. For other uses, see Panda (disambiguation).
PANDAS
Streptococcus pyogenes (stained red), a common group A streptococcal bacterium. PANDAS is hypothesized to be an autoimmune condition in which the body's own antibodies to streptococci attack the basal ganglion cells of the brain, by a concept known as molecular mimicry.
Specialty
Neurology
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a hypothesis that there exists a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders and these symptoms are caused by group A beta-hemolytic streptococcal (GABHS) infections.[1] The proposed link between infection and these disorders is that an initial autoimmune reaction to a GABHS infection produces antibodies that interfere with basal ganglia function, causing symptom exacerbations. It has been proposed that this autoimmune response can result in a broad range of neuropsychiatric symptoms.[2][3]
The PANDAS hypothesis was based on observations in clinical case studies at the US National Institutes of Health and in subsequent clinical trials where children appeared to have dramatic and sudden OCD exacerbations and tic disorders following infections.[4] There is supportive evidence for the link between streptococcus infection and onset in some cases of OCD and tics, but proof of causality has remained elusive.[5][6][7] The PANDAS hypothesis is controversial; whether it is a distinct entity differing from other cases of Tourette syndrome (TS)/OCD is debated.[3][8][9][10][11]
Contents
1 Characteristics
2 Mechanism
3 Diagnosis
3.1 Classification
4 Treatment
4.1 Experimental treatments
5 Society and culture
6 History
7 Research directions
8 See also
9 References
10 External links
Characteristics
In addition to an OCD or tic disorder diagnosis, children may have other symptoms associated with exacerbations such as emotional lability, enuresis, anxiety, and deterioration in handwriting.[1] In the PANDAS model, this abrupt onset is thought to be preceded by a strep throat infection. As the clinical spectrum of PANDAS appears to resemble that of Tourette's syndrome, some researchers hypothesized that PANDAS and Tourette's may be associated; this idea is controversial and a focus for current research.[3][8][9][10][11]
Mechanism
The PANDAS diagnosis and the hypothesis that symptoms in this subgroup of patients are caused by infection are controversial.[1][3][9][12][13][14]
Whether the group of patients diagnosed with PANDAS have developed tics and OCD through a different mechanism (pathophysiology) than seen in other people diagnosed with Tourette syndrome is unclear.[10][11][12][15] Researchers are pursuing the hypothesis that the mechanism is similar to that of rheumatic fever, an autoimmune disorder triggered by streptococcal infections, where antibodies attack the brain and cause neuropsychiatric conditions.[1]
The molecular mimicry hypothesis is a proposed mechanism for PANDAS:[16] this hypothesis is that antigens on the cell wall of the streptococcal bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with rheumatic fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham's chorea or "St. Vitus' Dance".[17] In a typical bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. In some rheumatic fever patients, autoantibodies may attack heart tissue, leading to carditis, or cross-react with joints, leading to arthritis.[16] In PANDAS, it is believed that tics and OCD are produced in a similar manner. One part of the brain that may be affected in PANDAS is the basal ganglia, which is believed to be responsible for movement and behavior. It is thought that similar to Sydenham's chorea, the antibodies cross-react with neuronal brain tissue in the basal ganglia to cause the tics and OCD that characterize PANDAS.[1][18] Studies neither disprove nor support this hypothesis: the strongest supportive evidence comes from a controlled study of 144 children (Mell et al, 2005), but prospective longitudinal studies have not produced conclusive results.[12]
Diagnosis
According to Lombroso and Scahill, 2008, "(f)ive diagnostic criteria were proposed for PANDAS: (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".[16] The children, originally described by Swedo et al in 1998, usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions.[19] Some studies have supported acute exacerbations associated with streptococcal infections among clinically defined PANDAS subjects (Murphy and Pichichero, 2002; Giulino et al, 2002); others have not (Luo et al, 2004; Perrin et al, 2004).[1]
Concerns have been raised that PANDAS may be overdiagnosed, as a significant number of patients diagnosed with PANDAS by community physicians did not meet the criteria when examined by specialists, suggesting the PANDAS diagnosis is conferred by community physicians without conclusive evidence.[12][20]
Classification
A possible relationship between PANDAS and other early-onset conditions.[18] Other sources note periods of remission[16] and extend PANDAS to other diagnoses such as ADHD.[4]
PANDAS is hypothesized to be an autoimmune disorder that results in a variable combination of tics, obsessions, compulsions, and other symptoms that may be severe enough to qualify for diagnoses such as chronic tic disorder, OCD, and Tourette syndrome (TS or TD). The cause is thought to be akin to that of Sydenham's chorea, which is known to result from childhood Group A streptococcal (GAS) infection leading to the autoimmune disorder acute rheumatic fever of which Sydenham's is one manifestation. Like Sydenham's, PANDAS is thought to involve autoimmunity to the brain's basal ganglia. Unlike Sydenham's, PANDAS is not associated with other manifestations of acute rheumatic fever, such as inflammation of the heart.[4] Pichechero notes that PANDAS has not been validated as a disease classification, for several reasons. Its proposed age of onset and clinical features reflect a particular group of patients chosen for research studies, with no systematic studies of the possible relationship of GAS to other neurologic symptoms. There is controversy over whether its symptom of choreiform movements is distinct from the similar movements of Sydenham's. It is not known whether the pattern of abrupt onset is specific to PANDAS. Finally, there is controversy over whether there is a temporal relationship between GAS infections and PANDAS symptoms.[4]
To establish that a disorder is an autoimmune disorder, Witebsky criteria require
that there be a self-reactive antibody,
that a particular target for the antibody is identified (autoantigen)
that the disorder can be caused in animals and
that transferring antibodies from one animal to another triggers the disorder (passive transfer).[21]
In addition, to show that a microorganism causes the disorder, the Koch postulates would require one show that the organism is present in all cases of the disorder, that the organism can be extracted from those with the disorder and be cultured, that transferring the organism into healthy subjects causes the disorder, and the organism can be reisolated from the infected party.[21] Giovanonni notes that the Koch postulates cannot be used in the case of postinfection disorders (such as PANDAS and SC) because the organism may no longer be present when symptoms emerge, multiple organisms may cause the symptoms, and the symptoms may be a rare reaction to a common pathogen.[21]
Treatment
Treatment for children suspected of PANDAS is generally the same as the standard treatments for TS and OCD.[2][5][15] These include cognitive behavioral therapy and medications to treat OCD such as selective serotonin reuptake inhibitors (SSRIs);[5][15] and "conventional therapy for tics".[2]
A controlled study (Garvey, Perlmutter, et al, 1999) of prophylactic antibiotic treatment of 37 children found that penicillin V did not prevent GABHS infections or exacerbation of other symptoms; however, compliance was an issue in this study. A later study (Snider, Lougee, et al, 2005) found that penicillin and azithromycin decreased infections and symptom exacerbation. The sample size, controls, and methodology of that study were criticized.[1] Murphy, Kurlan and Leckman (2010) say, "The use of prophylactic antibiotics to treat PANDAS has become widespread in the community, although the evidence supporting their use is equivocal. The safety and efficacy of antibiotic therapy for patients meeting the PANDAS criteria needs to be determined in carefully designed trials";[5] de Oliveira and Pelajo (2009) say that because most studies to date have "methodologic issues, including small sample size, retrospective reports of the baseline year, and lack of an adequate placebo arm ... it is recommended to treat these patients only with conventional therapy".[2]
Evidence is insufficient to determine if tonsillectomy is effective.[2]
Experimental treatments
Prophylactic antibiotic treatments for tics and OCD are experimental[6] and controversial;[12] overdiagnosis of PANDAS may have led to overuse of antibiotics to treat tics or OCD in the absence of active infection.[12]
A single study of PANDAS patients showed efficacy of immunomodulatory therapy (intravenous immunoglobulin (IVIG) or plasma exchange) to symptoms,[1] but these results are unreplicated by independent studies as of 2010.[16][12] Kalra and Swedo wrote in 2009, "Because IVIG and plasma exchange both carry a substantial risk of adverse effects, use of these modalities should be reserved for children with particularly severe symptoms and a clear-cut PANDAS presentation.[15] The US National Institutes of Health and American Academy of Neurology 2011 guidelines say there is "inadequate data to determine the efficacy of plasmapheresis in the treatment of acute OCD and tic symptoms in the setting of PANDAS" and "insufficient evidence to support or refute the use of plasmapheresis in the treatment of acute OCD and tic symptoms in the setting of PANDAS", adding that the investigators in the only study of plasmapherisis were not blind to the results.[8] The Medical Advisory Board of the Tourette Syndrome Association said in 2006 that experimental treatments based on the autoimmune theory such as IVIG or plasma exchange should not be undertaken outside of formal clinical trials.[22] The American Heart Association's 2009 guidelines state that, as PANDAS is an unproven hypothesis and well-controlled studies are not yet available, they do "not recommend routine laboratory testing for GAS to diagnose, long-term antistreptococcal prophylaxis to prevent, or immunoregulatory therapy (e.g., intravenous immunoglobulin, plasma exchange) to treat exacerbations of this disorder".[23]
Society and culture
The debate surrounding the PANDAS hypothesis has societal implications; the media and the Internet have played a role in the PANDAS controversy.[5][24] Swerdlow (2005) summarized the societal implications of the hypothesis, and the role of the Internet in the controversy surrounding the PANDAS hypothesis:
... perhaps the most controversial putative TS trigger is exposure to streptococcal infections. The ubiquity of strep throats, the tremendous societal implications of over-treatment (e.g., antibiotic resistance or immunosuppressant side effects) versus medical implications of under-treatment (e.g., potentially irreversible autoimmune neurologic injury) are serious matters. With the level of desperation among Internet-armed parents, this controversy has sparked contentious disagreements, too often lacking both objectivity and civility.[24]
Murphy, Kurlan and Leckman (2010) also discussed the influence of the media and the Internet in a paper that proposed a "way forward":
The potential link between common childhood infections and lifelong neuropsychiatric disorders is among the most tantalizing and clinically relevant concepts in modern neuroscience ... The link may be most relevant in this group of disorders collectively described as PANDAS. Of concern, public awareness has outpaced our scientific knowledge base, with multiple magazine and newspaper articles and Internet chat rooms calling this issue to the public's attention. Compared with ~ 200 reports listed on Medline—many involving a single patient, and others reporting the same patients in different papers, with most of these reporting on subjects who do not meet the current PANDAS criteria—there are over 100,000 sites on the Internet where the possible Streptococcus–OCD–TD relationship is discussed. This gap between public interest in PANDAS and conclusive evidence supporting this link calls for increased scientific attention to the relationship between GAS and OCD/tics, particularly examining basic underlying cellular and immune mechanisms.[5]
History
Susan Swedo first described the entity in 1998.[19] In 2008 Lombroso and Scahill described five diagnostic criteria for PANDAS.[16] Revised criteria and guidelines for PANDAS was established by the NIMH in 2012 and updated in 2017.[25][26]
Research directions
In a 2010 paper calling for "a way forward", Murphy, Kurlan and Leckman said: "It is time for the National Institutes of Health, in combination with advocacy and professional organizations, to convene a panel of experts not to debate the current data, but to chart a way forward. For now we have only to offer our standard therapies in treating OCD and tics, but one day we may have evidence that also allows us to add antibiotics or other immune-specific treatments to our armamentarium."[5] A 2011 paper by Singer proposed a new, "broader concept of childhood acute neuropsychiatric symptoms (CANS)", removing some of the PANDAS criteria in favor or requiring only acute-onset. Singer said there were "numerous causes for CANS", which was proposed because of the "inconclusive and conflicting scientific support" for PANDAS, including "strong evidence suggesting the absence of an important role for GABHS, a failure to apply published [PANDAS] criteria, and a lack of scientific support for proposed therapies".[27]
See also
Neurobiological brain disorder
References
^ Jump up to: a b c d e f g h Moretti G, Pasquini M, Mandarelli G, Tarsitani L, Biondi M (2008). "What every psychiatrist should know about PANDAS: a review". Clin Pract Epidemol Ment Health. 4 (1): 13. doi:10.1186/1745-0179-4-13. PMC 2413218  . PMID 18495013.
^ Jump up to: a b c d e de Oliveira SK, Pelajo CF (March 2010). "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS): a Controversial Diagnosis". Curr Infect Dis Rep. 12 (2): 103–9. doi:10.1007/s11908-010-0082-7. PMID 21308506.
^ Jump up to: a b c d Boileau B (2011). "A review of obsessive-compulsive disorder in children and adolescents". Dialogues Clin Neurosci. 13 (4): 401–11. PMC 3263388  . PMID 22275846.
^ Jump up to: a b c d Pichichero ME (2009). "The PANDAS syndrome". Adv Exp Med Biol. Advances in Experimental Medicine and Biology. Springer. 634: 205–16. doi:10.1007/978-0-387-79838-7_17. ISBN 978-0-387-79837-0. PMID 19280860. PANDAS is not yet a validated nosological construct.
^ Jump up to: a b c d e f g Murphy TK, Kurlan R, Leckman J (August 2010). "The immunobiology of Tourette's disorder, pediatric autoimmune neuropsychiatric disorders associated with Streptococcus, and related disorders: a way forward". J Child Adolesc Psychopharmacol. 20 (4): 317–31. doi:10.1089/cap.2010.0043. PMC 4003464  . PMID 20807070.
^ Jump up to: a b Shulman ST (February 2009). "Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update". Curr. Opin. Pediatr. 21 (1): 127–30. doi:10.1097/MOP.0b013e32831db2c4. PMID 19242249. Despite continued research in the field, the relationship between GAS and specific neuropsychiatric disorders (PANDAS) remains elusive.
Jump up ^ Maia TV, Cooney RE, Peterson BS (2008). "The neural bases of OCD in children and adults". Dev. Psychopathol. 20 (4): 1251–83. doi:10.1017/S0954579408000606. PMC 3079445  . PMID 18838041.
^ Jump up to: a b c Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A (January 2011). "Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology. 76 (3): 294–300. doi:10.1212/WNL.0b013e318207b1f6. PMC 3034395  . PMID 21242498.
^ Jump up to: a b c Felling RJ, Singer HS (August 2011). "Neurobiology of tourette syndrome: current status and need for further investigation". J. Neurosci. 31 (35): 12387–95. doi:10.1523/JNEUROSCI.0150-11.2011. PMID 21880899.
^ Jump up to: a b c Robertson MM (February 2011). "Gilles de la Tourette syndrome: the complexities of phenotype and treatment" (PDF). Br J Hosp Med (Lond). 72 (2): 100–7. doi:10.12968/hmed.2011.72.2.100. PMID 21378617.
^ Jump up to: a b c Singer HS (2011). "Tourette syndrome and other tic disorders". Handb Clin Neurol. Handbook of Clinical Neurology. 100: 641–57. doi:10.1016/B978-0-444-52014-2.00046-X. ISBN 9780444520142. PMID 21496613.
^ Jump up to: a b c d e f g Leckman JF, Denys D, Simpson HB, et al. (June 2010). "Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V" (PDF). Depress Anxiety. 27 (6): 507–27. doi:10.1002/da.20669. PMC 3974619  . PMID 20217853.
Jump up ^ Kurlan R, Kaplan EL (Apr 2004). "The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive–compulsive symptoms: hypothesis or entity? Practical considerations for the clinician" (PDF). Pediatrics. 113 (4): 883–86. doi:10.1542/peds.113.4.883. PMID 15060240.
Jump up ^ Shprecher D, Kurlan R (January 2009). "The management of tics". Mov. Disord. 24 (1): 15–24. doi:10.1002/mds.22378. PMC 2701289  . PMID 19170198.
^ Jump up to: a b c d Kalra SK, Swedo SE (April 2009). "Children with obsessive-compulsive disorder: are they just "little adults"?". J. Clin. Invest. 119 (4): 737–46. doi:10.1172/JCI37563. PMC 2662563  . PMID 19339765.
^ Jump up to: a b c d e f Lombroso PJ, Scahill L (2008). "Tourette syndrome and obsessive–compulsive disorder". Brain Dev. 30 (4): 231–7. doi:10.1016/j.braindev.2007.09.001. PMC 2291145  . PMID 17937978.
Jump up ^ Bonthius D, Karacay B (2003). "Sydenham's chorea: not gone and not forgotten". Semin Pediatr Neurol. 10 (1): 11–9. doi:10.1016/S1071-9091(02)00004-9. PMID 12785743.
^ Jump up to: a b Leckman JF, Bloch MH, King RA (2009). "Symptom dimensions and subtypes of obsessive–compulsive disorder: a developmental perspective" (PDF). Dialogues Clin Neurosci. 11 (1): 21–33. PMC 3181902  . PMID 19432385.
^ Jump up to: a b Swedo SE, Leonard HL, Garvey M, et al. (February 1998). "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases". Am J Psychiatry. 155 (2): 264–71. doi:10.1176/ajp.155.2.264. PMID 9464208.
Jump up ^ Shulman ST (February 2009). "Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update". Curr. Opin. Pediatr. 21 (1): 127–30. doi:10.1097/MOP.0b013e32831db2c4. PMID 19242249. Lay summary – PANDAS May Be Overdiagnosed, Contributing to Overuse of Antibiotics (October 26, 2006).
^ Jump up to: a b c Giavannoni G (2006). "PANDAS: overview of the hypothesis". Adv Neurol. Lippincott Williams & Wilkins. 99: 159–65. ISBN 0-7817-9970-8. PMID 16536362.
Jump up ^ Scahill L, Erenberg G, Berlin CM, et al. (April 2006). "Contemporary assessment and pharmacotherapy of Tourette syndrome" (PDF). NeuroRx. 3 (2): 192–206. doi:10.1016/j.nurx.2006.01.009. PMC 3593444  . PMID 16554257.
Jump up ^ Gerber MA, Baltimore RS, Eaton CB, et al. (March 2009). "Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics". Circulation. 119 (11): 1541–51. doi:10.1161/CIRCULATIONAHA.109.191959. PMID 19246689.
^ Jump up to: a b Swerdlow NR (September 2005). "Tourette syndrome: current controversies and the battlefield landscape". Curr Neurol Neurosci Rep. 5 (5): 329–31. doi:10.1007/s11910-005-0054-8. PMID 16131414.
Jump up ^ "Revised Treatment Guidelines Released for Pediatric Acute Onset Neuropsychiatric Syndrome (PANS/PANDAS)". www.liebertpub.com. Mary Ann Liebert, Inc. publishers.
Jump up ^ "Guidelines published for treating PANS/PANDAS". www.nimh.nih.gov. NIMH.
Jump up ^ Singer HS, Gilbert DL, Wolf DS, Mink JW, Kurlan R (December 2011). "Moving from PANDAS to CANS". J Pediatr. 160 (5): 725–31. doi:10.1016/j.jpeds.2011.11.040. PMID 22197466.
External links
Classification
D
ICD-10: D89.9
ICD-9-CM: 279.49
MeSH: C537163
External resources
Patient UK: PANDAS
Orphanet: 66624
PANDAS - Questions and Answers, National Institute of Mental Health
From Paresis to PANDAS, Former NIMH Director Thomas Insel, MD

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Obsessive–compulsive disorder (F42, 300.3)
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Neuroanatomy
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Brain-derived neurotrophic factor
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μ Opioid
H2
NK1
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Obsessions (associative
diagnostic
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Obsessive–compulsive personality disorder
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Tourette syndrome
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Tourette syndrome (F95.2, 307.23)
Main
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Coprolalia
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Hichki
Notable people
Mahmoud Abdul-Rauf
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Basshunter
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Brad Cohen
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Jamie Grace
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Dash Mihok
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Tobias Picker
Nick van Bloss
Michael Wolff
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