ABSTRACT
Lyme disease-induced hyperacusis can be an intensely disabling, chronic condition that is accompanied by posttraumatic stress disorder-like psychobehavioral sequelae. The authors describe effective treatment of 2 patients with carbamazepine. Speculations regarding a mode of action are offered.
Subject(s)
Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Hyperesthesia/drug therapy , Loudness Perception/drug effects , Lyme Disease/complications , Sensory Thresholds/drug effects , Adult , Carbamazepine/pharmacology , Female , Humans , Hyperesthesia/etiology , Kindling, Neurologic/drug effectsABSTRACT
Lyme Disease has been called "The New Great Imitator," a replacement for that old "great imitator" neurosyphilis. This article reviews the numerous psychiatric and neurologic presentations found in adults and children. It then reviews the features of Lyme Disease, which makes it almost uniquely hard to diagnose, including the complexity and unreliability of serologic tests. Clinical examples follow that illustrate those presentations of this disease that mimic attention deficit hyperactivity disorder (ADHD), depression, and multiple sclerosis.
Subject(s)
Lyme Disease/diagnosis , Mental Disorders/diagnosis , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Blotting, Western/standards , Borrelia burgdorferi Group/pathogenicity , Child , Depression/diagnosis , Diagnosis, Differential , Encephalitis, Tick-Borne/diagnosis , Encephalomyelitis/microbiology , Enzyme-Linked Immunosorbent Assay/standards , Humans , Lyme Disease/therapy , Meningitis, Bacterial/diagnosis , Mental Disorders/therapy , Middle Aged , Multiple Sclerosis/diagnosis , Neuropsychological Tests , Predictive Value of Tests , Serologic Tests/standardsABSTRACT
OBJECTIVE: Lyme disease is a multisystemic illness that can affect the central nervous system (CNS), causing neurologic and psychiatric symptoms. The goal of this article is to familiarize psychiatrists with this spirochetal illness. METHOD: Relevant books, articles, and abstracts from academic conferences were perused, and additional articles were located through computerized searches and reference sections from published articles. RESULTS: Up to 40% of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system. Dissemination to the CNS can occur within the first few weeks after skin infection. Like syphilis, Lyme disease may have a latency period of months to years before symptoms of late infection emerge. Early signs include meningitis, encephalitis, cranial neuritis, and radiculoneuropathies. Later, encephalomyelitis and encephalopathy may occur. A broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder. Depressive states among patients with late Lyme disease are fairly common, ranging across studies from 26% to 66%. The microbiology of Borrelia burgdorferi sheds light on why Lyme disease can be relapsing and remitting and why it can be refractory to normal immune surveillance and standard antibiotic regimens. CONCLUSIONS: Psychiatrists who work in endemic areas need to include Lyme disease in the differential diagnosis of any atypical psychiatric disorder. Further research is needed to identify better laboratory tests and to determine the appropriate manner (intravenous or oral) and length (weeks or months) of treatment among patients with neuropsychiatric involvement.
Subject(s)
Lyme Disease/diagnosis , Nervous System Diseases/diagnosis , Neurocognitive Disorders/diagnosis , Comorbidity , Diagnosis, Differential , Female , Humans , Lyme Disease/epidemiology , Male , Nervous System Diseases/epidemiology , Neurocognitive Disorders/epidemiology , Neuropsychological Tests , Prevalence , Recurrence , United States/epidemiologyABSTRACT
BACKGROUND: Lyme borreliosis (Lyme disease), a tick-borne spirochetal illness, has later manifestations that may include arthritic, neurologic, ophthalmologic, and cardiac symptoms. Recent reports suggest psychiatric symptoms may also be part of the clinical picture. METHOD: Using a structured interview (SCID), we interviewed three patients who had developed a psychiatric disorder for the first time after infection with Borrelia burgdorferi. RESULTS: During Lyme borreliosis, one patient had major depression and panic disorder, one patient had an organic mood syndrome with both depression and mania, and the third patient had panic disorder. These disorders remitted after adequate antibiotic treatment. CONCLUSION: While depression has been previously linked to neuroborreliosis, this is the first report to link panic disorder and mania with borrelial infection. Because of the rapid rise of Lyme borreliosis nationwide and the need for antibiotic treatment to prevent severe neurologic damage, mental health professionals need to be aware of its possible psychiatric presentations.
Subject(s)
Lyme Disease/complications , Mental Disorders/diagnosis , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/etiology , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Diagnosis, Differential , Female , Humans , Lyme Disease/diagnosis , Lyme Disease/psychology , Male , Mental Disorders/etiology , Middle Aged , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/etiology , Panic Disorder/diagnosis , Panic Disorder/etiology , Psychiatric Status Rating ScalesABSTRACT
A year's psychotherapy with a psychotic man during the author's residency training is described in detail. Fundamental questions regarding the patient's potential for therapeutic change are raised. These questions concerning this specific patient are then generalized to broader research questions regarding the efficacy of treatment for the severely and persistently mentally ill.
Subject(s)
Psychoanalytic Therapy , Psychotic Disorders/therapy , Adult , Delusions/psychology , Delusions/therapy , Humans , Internship and Residency , Male , Professional-Patient Relations , Psychiatry/education , Psychoanalytic Therapy/education , Psychotic Disorders/psychologyABSTRACT
Lyme borreliosis (Lyme disease), a tick-borne spirochetal illness, has multisystemic involvement and is rapidly increasing in certain areas of the United States. Although its neurologic manifestations are becoming increasingly well recognized, its psychiatric presentations are not well known. The first section of this paper will provide an overview of Lyme borreliosis and a review of the relevant neuropsychiatric literature. The second section will provide clinical descriptions of some common neuropsychiatric symptoms as well as a discussion of the problems typically faced by patients with this illness. Guidelines to assist the clinician in working with these patients will be presented.
