The Neuropsychiatric Assessment of Lyme Disease

[Yvonne]

Arthritis Rheum. 2008 Nov 26;59(12):1742-1749. [Epub ahead of print]Related Articles, Links

Role of psychiatric comorbidity in chronic Lyme disease.

Hassett AL, Radvanski DC, Buyske S, Savage SV, Gara M, Escobar JI, Sigal LH.

University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick.

OBJECTIVE: To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD). METHODS: We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease). RESULTS: After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients. CONCLUSION: Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

PMID: 19035409

[Claudia]

So it looks like L. Sigal et al are stating (Role of psychiatric comorbidity in chronic Lyme disease) that people with chronic Lyme disease are more likely to have psychiatric problems (in other words they are nuts to begin with), than that chronic Lyme disease infection is the medical cause for psychiatric manifestations?

[cave76]

Yeah, and not only that----- Klinghardt now has this up and running. (If it was running before I didn't know)

http://www.klinghardtneurobiology.com/

So, if you cross Lenny with Klingy , what do you get?????

[OneGuest]

Exactly exactly exactly, and this will reinforce GP's perceptions.
I also think that Fallon's work will play a role in this.

There will be an abuse of the statistics of prevalence. They
will not be able to separate out the effects of continuing abuse by
the medical community, and effects of misdiagnoses.

Thus their stat's will be misinterpreted.

OneGuest

[Yvonne]

Delirium and Lyme Disease:

http://psy.psychiatryonline.org/cgi/pdf_extract/36/1/69

[Yvonne]

Late-stage neuropsychiatric Lyme borreliosis :

In this report, we present two patients in whom psychiatric symptoms represented the primary manifestation of their late -stage Lyme Borreliosis.

http://psy.psychiatryonline.org/cgi/pdf ... t/36/3/295

[Yvonne]

http://journals.lww.com/clinicalpain/pa ... e=abstract

Abstract:

Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.

[Yvonne]

Neurol. 1992 Mar;239(3):129-31.

Untreated neuroborreliosis: Bannwarth's syndrome evolving into acute schizophrenia-like psychosis. A case report.

Roelcke U, Barnett W, Wilder-Smith E, Sigmund D, Hacke W.

Neurologische Klinik, Universität, Heidelberg, Federal Republic of Germany.

In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.

PMID: 1573415

[Yvonne]

Powerpoint presentation Dr. Ann F Corson Neuropsychiatric manifestiations of Tick Borne Disease :

http://www.lymedisease.org/resources/ch ... Rounds.pdf

[Yvonne]

J.Neurol. 1988 Jan;235(3):140-2.

Chronic borrelia encephalomyeloradiculitis with severe mental disturbance

immunosuppressive versus antibiotic therapy.

Kollikowski HH, Schwendemann G, Schulz M, Wilhelm H, Lehmann HJ.

Neurologische Universitätsklinik und Poliklinik Essen, Federal Republic of Germany.

A 57-year-old male was repeatedly admitted to hospital because of complex neurological symptoms, including radicular pain, disturbance of micturition, seizures, and severely impaired mental state. The diagnosis was encephalomyeloradiculitis possibly of viral origin, and treatment with immunosuppressants was initiated. An alternating course with a tendency towards improvement ensued. Two and a half years after the occurrence of the initial symptoms, identification of specific antibodies in the blood and CSF led to the diagnosis of borreliosis with CNS involvement. High-dose therapy with penicillin rapidly reduced the symptoms, beginning with those of radicular pain and followed by an improvement of the mental state. Attention is directed to the wide spectrum of clinical symptoms of chronic borreliosis with CNS involvement. Previous reports that immunosuppression may result in some improvement but with a tendency towards relapse are confirmed. Our encouraging treatment results support those of other reports that penicillin therapy may lead to improvement even at late chronic stages in patients with severe CNS deficits.

PMID: 3367160