Psychiatric Comorbidity and Other Psychological Factors in Patients with “Chroni

[Guest guest]

American Journal of Medicine

Official Journal of the Association of Professors of Medicine

 

 

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.â€

_a_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff1)

Division of Rheumatology and Connective Tissue Research,

University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical

School, New Brunswick, NJ

_b_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff2)

Department of Medicine, University of Medicine and Dentistry of

New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ

_c_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff3)

Department of Statistics, Rutgers University, Piscataway, NJ

_d_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff4)

Lyme Disease Center, University of Medicine and Dentistry of New

Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ

_e_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff5)

Department of Molecular Genetics & Microbiology, University of

Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New

Brunswick, NJ

_f_

(http://www.amjmed.com/article/PIIS0002934309003428/abstract?rss=yes#back-aff6)

Pharmaceutical 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.

PII: S0002-9343(09)00342-8

doi:10.1016/j.amjmed.2009.02.022

© 2009 Elsevier Inc. All rights reserved.