Cognitive function in post-treatment Lyme disease: do additional antibiotics help?

BACKGROUND: It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD). OBJECTIVE: To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD. METHODS: A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory. RESULTS: There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo. CONCLUSION: Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

Clinical and neurocognitive features of the post Lyme syndrome.

OBJECTIVE: To evaluate neurocognitive impairment in patients with persistent arthralgia, fatigue, and subjective memory loss in patients after Lyme disease (post-Lyme syndrome, PLS). METHODS: We compared the clinical, neurocognitive, and psychological features of 23 patients with PLS to 23 age, sex, and education matched recovered patients (REC). All met Centers for Disease Control criteria for Lyme disease, were ELISA positive at onset of Lyme disease and were previously treated with standard antibiotic regimens. RESULTS: Of the patients with PLS, 7 (30%) had fibromyalgia (FM), 3 (13%) had chronic fatigue syndrome, and 10 (43%) had similar but milder symptoms but did not meet the criteria for either. 22 of 23 patients with PLS complained of decreased memory or concentration problems. Patients with PLS had significantly lower scores on the attention/concentration scale (p = 0.012) of the Wechsler Memory Scale-Revised (WMS-R), indicating lowered attention/concentration. 52% of patients with PLS and 35% in the REC group had significantly lower (p < 0.05) WMS-R verbal memory scores than visual memory scores. The PLS group had subjectively more problems with sleep and mood changes and higher scores on several scales of Symptom Check List 90-R (p < 0.01), indicating greater physical distress. Beck Depression Inventory scores were also higher for the PLS than the REC group (p < 0.005), but were within the normal range. CONCLUSION: Despite antibiotic treatment, a sequelae of Lyme disease may be a PLS characterized by persistent arthralgia, fatigue, and neurocognitive impairment that is probably induced by Lyme disease.

Medical school, psychosocial attitudes, and gender.

A scale measuring empathy and a scale measuring attitudes toward social issues and human relations in health care were administered to medical students when they were applicants to medical school and again midway through their third year. Students in their third year exhibited less positive and/or more negative attitudes compared to their scores as applicants. The changes were largest in areas relating to social issues, such as government involvement in health care, and least in areas relating to human relations, such as the role of social factors as determinants of a patient's health or illness. There were few differences between women and men on these scales. These data suggest that attitudes toward the interpersonal aspect of patient care may be less severely affected by the medical school experience than previously expected, and that the medical school experience does not affect women's attitudes differently than it does men's.

Attitudes of medical students and faculty toward cancer.

The Cancer Attitude Survey (CAS) was administered to second year students before, during, and after a year-long "Introduction to Clinical Medicine" course. The course contained a 14-hour oncology segment. Faculty of the Clinical Medicine Course and nonclinical faculty teaching oncology related topics also responded to the CAS. The CAS contains four scales: Attitudes toward: I, the patient's inner resources to cope with cancer; IIA, the value of early diagnosis; IIB, aggressive treatment; and III, personal immortality and preparation for and acceptance of death. At the beginning of the course, student attitudes were positive; there was no change in attitudes across the three testing periods. Among faculty, dedicated oncologists had the most positive attitudes; students and nononcology clinical faculty exhibited similar trends in attitudes; nonclinical faculty teaching oncology related material had least positive attitudes.

Maintenance of psychosocial attitudes in medical students.

Attitudes of medical students towards the psychosocial aspects of illness is of serious concern to medical educators. It is thought that medical students are overwhelmingly disease-oriented and not sufficiently sensitive to the role of the psychological, emotional, sociological and economic factors in the etiology and management of illness. In the present study the ATSIM (Attitudes Towards Social Issues in Medicine) was presented to third year medical students and compared with their responses obtained 2 years previously when they were first year students. The data suggest that third year medical students have positive attitudes towards certain psychosocial issues (the importance of social factors as determinants of health or illness, the role of preventive medicine in maintaining health, the role of physician-patient interactions in patient care). These attitudes were positive during the students' first year and have been maintained during the course of medical school. These finding are contrary to previous studies which indicate a deterioration in attitudes during the course of medical school.

Phencyclidine in an East Harlem psychiatric population.

The use of phencyclidine (PCP) was investigated in the psychiatric population of an East Harlem, New York, hospital. Sixty-eight consecutive PCP-user admissions were interviewed through a 77-item questionnaire. The patient population served by the facility was 48 percent Hispanic and 32 percent black. The sample of PCP users was 86 percent black. This suggests that, in this area, either more blacks use PCP, or nonblack PCP users seek psychiatric help less frequently than black users. This study emphasizes the many problems affecting the sample population and shows evidence that a large portion of the sample is at risk to develop psychiatric symptoms.

Effects of an ACTH short chain neuropeptide in man.

The authors studied the effect of an ACTH 4-9 analogue (the shortest behaviorally active fragment of the ACTH neuropeptide) on mood in normal aging volunteers. These mood changes, described as a sense of well-being, energy, and drive, are consistent with an arousal-stimulant mechanism of action of the compound. No effect of the compound was found on attention or memory. Because of its apparent safety and the lack of adverse effects, the authors suggest that this short chain neuropeptide be further explored in older individuals for its mood-elevating and potential antidepressant properties.

The pre- and post-therapy measurement of communication skills of couples undergoing sex therapy at the Masters & Johnson Institute.

A battery of five paper and pencil questionnaires designed to measure empirically 10 specific skills hypothesized to be involved in effective interpersonal communication was employed to assess the pre- and post-therapy levels of these skills in couples undergoing treatment for sexual dysfunction at the Masters & Johnson Institute in St. Louis, Missouri. The females exhibited significant increases across the 2-week period of therapy for the following skills: positive assertion in intimate heterosexual peer relationships, assertiveness, verbal expression of feelings, and nonmaterial support and evidence of love. For the males significant increases in the following skills were obtained: assertiveness, verbal expression of feelings, self-disclosure, and tolerance of the less pleasant aspects of the loved one. A significant decrease was observed for the skill entitled feelings not expressed verbally to the loved one. Thus, both the females and males became more assertive and more able to express their feelings openly and thus more able to share more of themselves with their partners as a result of the therapy. These results lend empirical support to Masters and Johnson's theoretical model of communication and to the view that much more than simple behavior therapy is involved in a successful sex therapy program.

Naloxone fails to affect short-term memory in man.

The effects of naloxone on memory were studied in 26 healthy male volunteers. Either placebo, or 10 mg, or 20 mg of naloxone was given iv on separate occasions. Ten minutes after each injection, the subjects listened to 8 lists of words (10 words on each list). Immediate recall, delayed recall, and delayed recognition were not affected by naloxone within 60 minutes of its administration. These results provide no support for the hypothesis that edorphins play a role in the short-term auditory memory in man.