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Am J Psychiatry 1994; 151:1571-1583
Copyright © 1994 by American Psychiatric Association
Lyme disease: a neuropsychiatric illness
BA Fallon and JA Nields
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
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.
This article has been cited by other articles:
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