When Infections Masquerade as Mental Illness

When sudden mood swings or rage don’t respond to treatment, infections may be the culprit. In this episode of Demystifying PANS/PANDAS, Dr. Rosalie Greenberg, a child and adolescent psychiatrist, explains how hidden infections can inflame the brain and trigger psychiatric symptoms. She shares real stories, warning signs to watch for, and a practical three-step approach: treat the infection, calm the immune system, and ease symptoms so kids can get their childhood back.

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When parents say something’s wrong, they’re usually right. In this episode of Demystifying PANS/PANDAS, Dr. Rosalie Greenberg shares how many kids once labeled with psychiatric disorders—like bipolar or even schizophrenia—were actually battling hidden infections. She describes dramatic turnarounds, like a teen misdiagnosed with schizophrenia who improved once treated for Bartonella.

Dr. Greenberg explains why some medications (like antidepressants) can backfire in vulnerable kids, and how to use them more safely by starting very low, increasing slowly, and always watching for family history of bipolar disorder. She also notes how ‘psychiatric herx’ reactions during treatment sometimes ease with simple anti-inflammatories. Her bottom line is simple but powerful: be a detective, listen to parents, and never ignore sudden changes in a child’s behavior.

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Dr. Rosalie Greenberg is a board-certified adult, child, and adolescent psychiatrist recognized for her expertise in complex childhood psychiatric disorders and pediatric psychopharmacology. She earned her MD from Columbia University College of Physicians and Surgeons, where she also completed her residency and fellowship, later serving as chief resident and a longtime faculty member.

With over four decades of experience, she has authored books, research articles, and produced educational media addressing topics from adolescent suicide and pediatric bipolar disorder to the psychiatric impact of infections. Practicing in New Jersey, she was among the first to highlight the connection between tick-borne illnesses and psychiatric symptoms in children, often in cases where no tick bite was known. Today, her private practice in Summit, New Jersey, focuses on the psychiatric manifestations of infectious and immune-related diseases in youth, while she continues to lecture nationally and internationally on children’s mental health.

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Rosalie Greenberg, MD

Website: https://www.rosaliegreenbergmd.com/

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Nancy O’Hara, MD, MPH, FAAP, FMAPS

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