Psychiatric Comorbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”

Abstract

Background-There is no evidence of current or previous B. burgdorferi infection in most patients evaluated at University-based Lyme disease referral centers. Instead, psychological factors likely exacerbate the persistent diffuse symptoms or "Chronic Multisymptom Illness" incorrectly ascribed to an ongoing chronic infection with B. burgdorferi. The objective of this study was to assess the medical and psychiatric status of such patients and compare these findings to those from patients without CMI.

Estimation of cognitive and affective disorders occurrence in patients with Lyme borreliosis

“…Mild depressive or anxiety disorders interpreted as situational reactions (often with depressive mood) are among the most frequent abnormalities, which was also proved by the presented study. Similar observations were made by American researchers who noted depressive disorders and general anxiety disorder (GAD) in 49% of patients with LB [35]. Studies concerning comorbidity of LB or neuroborreliosis and affective disorders and cognitive deficits are relatively uncommon in the literature and some of them include case studies.…”

The epidemiology, prevention, investigation and treatment of Lyme borreliosis in United Kingdom patients: A position statement by the British Infection Association

“…29,30 In prospective and retrospective studies many patients labelled as having "chronic Lyme disease" fell into the last category and had received the diagnosis because poorly-specific case definitions and/or unvalidated, poorly-specific laboratory tests had been applied. 31 The IDSA Guidelines Review Panel reiterated the 2006 USA guidelines' recommendation that, "Whatever definition is eventually adopted, having once had objective clinical or laboratory evidence of B. burgdorferi infection must be a condition sine qua non until a syndrome is formally defined.". 15 The BIA shares the view that only a formallydefined syndrome specific for chronic Lyme disease will obviate the need for previous clinical or laboratory evidence of B. burgdorferi infection.…”

“…30,31,40,41 Many patients have received potentially dangerous treatments, including prolonged courses of antibiotics, antiparasitic and other agents and have lost opportunities for appropriate management of their conditions. The Association recommends that patients presenting with symptoms and history not typical of Lyme borreliosis should be investigated according to good medical practice, and that investigations for Lyme borreliosis should be performed only if there are good clinical and epidemiological indications.…”

Chronic Lyme disease: the controversies and the science

“…A substantial number were diagnosed with Lyme disease based on an inability to make an alternative diagnosis -referred to in one paper as 'diagnosis of Lyme disease by exclusion' [36]. Primary psychiatric diagnoses, psychiatric comorbidity and psychological traits such as catastrophization and negative affect are also common [32,34]. Many had symptoms of long duration and had received multiple courses of antibiotics directed at Lyme disease.…”

“…In seven studies conducted in endemic areas, comprising a total of 1902 patients referred for suspected Lyme disease, only 7-31% had active Lyme disease and 5-20% had previous Lyme disease [31][32][33][34][35][36][37]. Among the remainder, 50-88% had no evidence of ever having had Lyme disease (Figure 1).…”