Brita List - Clinical Psychologist

10/10/2026

LEARNING: variably compromised in PANS flares! I find Alzheimers research has concepts that relate to the clinical features and hypothesised neuroanatomy affected in PANS. Alzheimers: too little dopamine. PANS: Dysregulated dopamine (both up and down?).

Quote from this post.
"Dopamine isn’t just involved in motivation and reward. It also plays an important role in learning, memory, and emotional processing... potentially contributing to memory difficulties, apathy, and changes in mood... with mild cognitive impairment... Changes in specific brain circuits and neurotransmitter systems could also help explain its cognitive and emotional symptoms."
+++

This 2019 systematic review doesn't go into impacted function. https://doi.org/10.3389/fnagi.2019.00175

britapsych.com

🧠 Could dopamine neuron loss play an important role in Alzheimer’s disease?

When we think about Alzheimer’s disease, we usually focus on amyloid plaques, tau tangles, and memory loss. But there’s another interesting part of the story: dopamine.

Dopamine isn’t just involved in motivation and reward. It also plays an important role in learning, memory, and emotional processing. A 2019 study suggests that dopamine-producing neurons in the ventral tegmental area (VTA) may become vulnerable during Alzheimer’s disease, potentially contributing to memory difficulties, apathy, and changes in mood.

Interestingly, alterations in VTA connectivity have also been observed in people with mild cognitive impairment, raising questions about how early dopamine-related changes might occur. Alzheimer’s may involve more than amyloid and tau. Changes in specific brain circuits and neurotransmitter systems could also help explain its cognitive and emotional symptoms.

This remains an evolving area of research, but it offers an interesting perspective on neurodegeneration. Important to mention, in case you're interested in learning deeper applied neuroscience: https://www.patreon.com/betterbrain

Reference: Krashia et al., (2019)

02/10/2026

Australian Petition: "Children Don’t Stop Being Sick When They Turn 18 — End Medical Age Cut Offs"
https://c.org/rx9htBnwyg

Children Don’t Stop Being Sick When They Turn 18 — End Medical Age Cut Offs

25/09/2026

This parent speaks of a real but RARE experience. Real sub-group minorities can easily disappear within statistical analysis of large cohorts.

Limitations Page 7: This paper did not have resources to control for family immune condition history, which is directly relevant to PANS and PANDAS. It was designed to look at a general paediatric cohort.

Discussion Page 7: "...the importance of accounting for genetic vulnerability when evaluating the impact of severe infection on psychiatric outcomes."

Conclusion Page 8:"This does not rule out the existence of rare, biologically distinct, putatively immunemediated neuropsychiatric subgroups after streptococcal infection, but establishing this requires careful, scrupulously matched clinical studies using established biomarkers of autoimmunity, ideally with concurrent demonstration of in vitro or in vivo pathogenicity."

Abstract Page 1: This paper's summary conclusion is, unfortunately, still going to be influential in strengthening the position of gatekeepers declining/delaying medical treatment for PANS/PANDAS: "...found no evidence that exposure to S. pyogenes is associated with increased risk of the measured psychiatric outcomes".

A quick google pulled a few articles on the unreliability of strep labs
https://pmc.ncbi.nlm.nih.gov/articles/PMC5631577/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10654965/
https://pubmed.ncbi.nlm.nih.gov/3946880/
https://learnmuscles.com/blog/2025/03/24/why-strep-tests-sometimes-get-it-wrong/

Evidence of biological validity of PANS and responsivity to treatment:

Han, V.X., Alshammery, S., Keating, B.A. et al. Epigenetic, ribosomal, and immune dysregulation in paediatric acute-onset neuropsychiatric syndrome. Mol Psychiatry 30, 5389–5404 (2025). https://doi.org/10.1038/s41380-025-03127-5

Abstract: "Given the central role of the immune system in synaptic pruning and neurodevelopment, these insights provide rationale for novel epigenetic and immune modulating therapies to optimize neurodevelopmental trajectories and minimize neuropsychiatric impairment in PANS."

britapsych.com

Psychiatric outcomes after streptococcal upper respiratory tract infection in children - Volume 56

19/09/2026

Stating - a plan exists - is not the same as creating a realistic plan which the child has capacity to utilise.
britapsych.com

I have seen this SO many times.

Why does it happen?

Because of the classroom culture.

Our kids often learn from the second they arrive at school that sameness is currency. Being the same as everyone else is safe, it is encouraged, it is celebrated, it is rewarded.

It starts with the teacher- their lens, their language, and their expectations.
It continues with the rules and classroom management.

Our kids who are different can see it.
They notice that conformity gets rewarded.
They notice that doing something different from everyone else does not get rewarded, it gets tolerated. And worse still- it often gets called out.
Every kid in that class learns what the ‘right’ things are.

Sameness is often the default.
There are often blanket classroom rules.
Some kids who are different get given ‘exceptions’.
They get accommodations approved.
Now they don’t have to do the ‘right’ thing in class because they have an important letter that says so.

A lot of our kids won’t use them.
And god, they often get blamed for that.

When doing something different is rarely seen in the classroom, it sticks right out. And our kids just will not out themselves into that position.
It takes a lot of courage to stand out when difference is discouraged and sameness has been forever celebrated.

When affirming accommodations are retroactively fitted into a classroom that teaches sameness- they are not accessible.

The classroom needs to celebrate difference and individuality first.
When it does, being the only kid to need a set of headphones won’t feel unbearable.

We have to start there.

Em 🌈

17/09/2026

PANS and Learning - Therapy and School:
I have just uploaded ANOTHER new handout, but I haven't made pretty canva images yet. I was writing to a paediatrician with considerations for a child with PANS returning to school, and realised there's an opportunity to make it generic for broader distribution.
https://drive.google.com/file/d/1TWj3woDXOv987TWj4udM_jMCWKzwo24p/view
Considerations for PANS and capacity to 'learn' both in therapy and in school.
Basal ganglia post: https://www.facebook.com/share/p/17dbXKze4F/
More handouts here: https://www.britapsych.com/panspandas/clinical-observations
PANS Evidence for biological validity
PANS and assumptions in CBT
PANS and learning - therapy and school
PANS in schools
PANS and PDA in flares
PANS and psychiatric medicine - research
PANS and immune investigations
Brita PANS info for clients
britapsych.com

06/09/2026

I have just uploaded a new handout, but I haven't made pretty canva images yet. For now it is AI assisted and reviewed by me, but these ideas (along with my basal ganglia post) are what drove me to the PhD. So one day I will do a lot more with these ideas!
https://drive.google.com/file/d/10OBZvafxd8noUgkiHyRh1CepFWLF5fIr/view
Assumptions in Cognitive Behaviour Therapy (and where PANS violates so many of these assumptions - fluctuating-ly and unpredictably!)
Basal ganglia post: https://www.facebook.com/share/p/17dbXKze4F/
More handouts here: https://www.britapsych.com/panspandas/clinical-observations
britapsych.com

29/08/2026

Privilege comes in many forms. Including a healthy child; and an "easy child".
britapsych.com

24/07/2026

This might be worth checking in all PANS presentations??

https://pubmed.ncbi.nlm.nih.gov/26063047/

Quote from the abstract:
The results of this study indicate that there are alterations in plasma levels of [Copper] and [Zinc] as well as significant relationships to symptoms of ADHD.

britapsych.com

24/07/2026

My friend and fellow PANS PhD-er Sam spoke about her recently published research, as well as this article telling the story of a family's PANS experience.

britapsych.com

Luca caught a respiratory virus. It changed his brain. Her little boy looked ‘possessed’ by a mystery illness that many doctors dismiss – and the family’s ordeal is far from unique.

Read more: https://bit.ly/4fxPaNv

24/07/2026

POTS Shows a Distinct Inflammatory Signature
https://doi.org/10.3390/biomedicines14071605

Quote from abstract:
Conclusions: These associative findings suggest that pre-pandemic POTS and Long COVID-associated POTS share a distinct inflammatory profile among measured cytokines. The identification of IL-18 as a key biomarker, alongside Caspase-1p20 and other inflammatory cytokines, are compatible with inflammasome-related signaling. Further investigation is necessary to characterize the role of the inflammasome, platelet activation, and immune dysregulation in POTS and Long COVID.
britapsych.com

NEW RESEARCH 🔬 🧐

Thanks to Dysautonomia International for this important 🆕 IMMUNE RESEARCH showing elevated inflammatory cytokines, indistinguishable inflammatory cytokine profiles with INTERLEUKIN-18 standing out and MORE ‼️

The researchers state 🎙️….
“A state of persistent inflammation with a lack of effective resolution by the immune system” is present.

Link to article in our bio and stories 🔗