LYME-DISEASE - A NEUROPSYCHIATRIC ILLNESS

Objective: Lyme disease is a multisystemic illness that can affect the central nervous system (CNS), causing neurologic and psychiatric symp toms. The goal of this article is to familiarize psychiatrists with th is spirochetal illness. Method: Relevant books, articles, and abstract s from academic conferences were perused, and additional articles were located through computerized searches and reference sections from Pub lished articles. Results: Up to 40% of patients with Lyme disease deve lop 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. Ea rly signs include meningitis, encephalitis, cranial neuritis, and radi culoneuropathies. Later, encephalomyelitis and encephalopathy may occu r. A broad range of psychiatric reactions have been associated with Ly me disease including paranoia, dementia, schizophrenia, bipolar disord er, panic attacks, major depression, anorexia nervosa, and obsessive-c ompulsive disorder. Depressive states among patients with late Lyme di sease are fairly common, ranging across studies from 26% to 66%. The m icrobiology of Borrelia burgdorferi sheds light on why Lyme disease ca n be relapsing and remitting and why it can be refractory to normal im mune surveillance and standard antibiotic regimens. Conclusions: Psych iatrists 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 determin e the appropriate manner (intravenous or oral) and length (weeks or mo nths) of treatment among patients with neuropsychiatric involvement.