Aspectos psicologicos

CLINICAL RESEARCH STUDY

Psychiatric Comorbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”
Afton L. Hassett, PsyD,a,b Diane C. Radvanski, MS,a Steven Buyske, PhD,c Shantal V. Savage, BA,a Leonard H. Sigal, MDa,b,d,e,f
Division of Rheumatology and Connective Tissue Research and bDepartment of Medicine, University of Medicine and Dentistry of New Jersey-Robert WoodJohnson Medical School, New Brunswick, NJ; cDepartment of Statistics, Rutgers University, Piscataway, NJ; d Lyme Disease Center and eDepartment of Molecular Genetics & Microbiology, University of Medicine and Dentistry of New JerseyRobert Wood Johnson Medical School, New Brunswick, NJ; fPharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, NJ.
a

ABSTRACT BACKGROUND: There is noevidence of current or previous Borrelia 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” (CMI) incorrectly ascribed to an ongoing chronic infection with B. burgdorferi. The objective of this study was to assess the medical andpsychiatric status of such patients and compare these findings to those from patients without CMI. METHODS: There were 240 consecutive patients who underwent medical evaluation and were screened for clinical disorders (eg, depression and anxiety) with diagnoses confirmed by structured clinical interviews at an academic Lyme disease referral center in New Jersey. Personality disorders, catastrophizing, andnegative and positive affect also were evaluated, and all factors were compared between groups and with functional outcomes. RESULTS: Of our sample, 60.4% had symptoms that could not be explained by current Lyme disease or another medical condition other than CMI. After adjusting for age and sex, clinical disorders were more common in CMI than in the comparison group (P .001, odds ratio 3.54, 95%confidence interval, 1.97-6.55), but personality disorders were not significantly more common. CMI patients had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P .001) than did the comparison group. Except for personality disorders, all psychological factors were related to worse functioning. Our explanatory model based on these factors was confirmed.CONCLUSIONS: Psychiatric comorbidity and other psychological factors are prominent in the presentation and outcome of some patients who inaccurately ascribe longstanding symptoms to “chronic Lyme disease.” © 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009) 122, 843-850 KEYWORDS: Anxiety; Chronic Lyme disease; Chronic Multisymptom Illness; Depression; Fibromyalgia;Lyme disease; Psychiatric comorbidity

Funding: The National Institute of Mental Health grant number 1 K08MH65360-01. Conflict of Interest: Afton L. Hassett, PsyD, Principal Investigator and corresponding author: Dr. Hassett does not have any conflicts of interest associated with this study. For full disclosure, Dr. Hassett has other research funded by Bristol-Myers Squibb (BMS) and is a consultantto BMS and Forest Laboratories; however, this study was not funded by either. There is no foreseeable way for her to gain financially by the results reported herein. Diane C. Radvanski, MS, Senior Research Assistant: No conflicts of interest to report. Steven Buyske, PhD, Statistician: Dr. Buyske has no conflicts of interest to report. He does have subcontracts to analyze data related to Dr. Hassett’sother research funded by BMS. Shantal V. Savage, BA, Research Assistant: No conflicts of interest to report.

Lyme disease is a multisystem inflammatory disorder due to a symptomatic infection with the tick-borne organism Borrelia burgdorferi.1 Clinical features, including erythema migrans rash, musculoskeletal pain, and joint inLeonard H. Sigal, MD, Senior Author: Dr. Sigal is the Director of...