Psychiatric Comorbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”
Abstract
Background
There is no evidence 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 and psychiatric 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, and negative 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.”
aDivision of Rheumatology and Connective Tissue Research, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
bDepartment of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
cDepartment of Statistics, Rutgers University, Piscataway, NJ
dLyme Disease Center, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
eDepartment of Molecular Genetics & Microbiology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
fPharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, NJ
Requests for reprints should be addressed to Afton L. Hassett, PsyD, UMDNJ-Robert Wood Johnson Medical School, 1 R W Johnson Place MEB-484, New Brunswick, NJ 08903-0019
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 consultant to 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's other research funded by BMS.
Shantal V. Savage, BA, Research Assistant: No conflicts of interest to report.
Leonard H. Sigal, MD, Senior Author: Dr. Sigal is the Director of the Pharmaceutical Research Institute at Bristol-Myers Squibb (BMS); however, this study was not funded by BMS, and Dr. Sigal does not stand to gain financially by the results reported herein.
Authorship: All authors had access to the data and a meaningful role in writing this manuscript.
ABSTRACT
