Sudden Psychoses Could Point to Lyme
FRIDAY, Nov. 17 (HealthScout) -- The young man went to see a psychiatrist after he'd picked up a friend and thrown him down a flight of stairs. At work, he'd slammed a co-worker against a wall. He'd never had these kinds of aggressive outbursts before and was genuinely frightened by his behavior.
But the psychiatrist, Dr. Brian Fallon, an associate professor of psychiatry at Columbia University, noticed something else. Six months earlier, the man had complained of having trouble putting his words together. Diagnosis: Lyme disease.
"He had a classic case of Lyme disease," says Fallon, who also is director of the Lyme Disease Research Program at the New York State Psychiatric Institute.
Caused by the Borrelia burgdorferi bacterium and transmitted by tiny deer ticks, Lyme disease has been reported in nearly every state and throughout Europe and Asia. It begins as a skin rash, and early symptoms often are flu-like, including fatigue, headache, fever, muscle stiffness and joint pain.
But if not treated early, Lyme disease can attack the central nervous system and produce a variety of psychiatric disorders, "from depression to full-blown psychosis," Fallon says. "Panic attacks or new onset irritability, insomnia, concentration problems and depression, or what may look like depression, may actually be undiagnosed Lyme disease," he says.
That's why it's called "The Great Imitator," Fallon says: Lyme disease symptoms are similar to those of a host of other medical conditions. And that's also why a psychiatrist can be important in diagnosing the disease, he says. Fallon discussed his work at an American Psychiatric Association meeting a few weeks ago.
"Psychiatrists can be very helpful," he says. "We know what panic attacks and depression look like. If a patient also has numbness and tingling, migrating joint pains and a hard time finding the words to say what they want to say -- instead of 'convertible,' they might say 'a car without a roof on it' -- that's classic in Lyme disease, but you don't typically see it with depression."
Plus, the standard blood tests for Lyme disease have a significant rate of both false positives and negatives, he says, creating a significant number of misdiagnoses.
Dr. Edward Truemper, director of pediatric intensive care at the Clute Barrow Nelson Children's Center at St. Mary's Hospital in Athens, Ga., says he's seen enough Lyme disease with neuropsychiatric features - from seizures to altered mental status -- to always ask where a younger patient lives and plays, and whether the child has pets.
"The ticks for Lyme disease are on deer, dogs and cats," Truemper says. "If [pets] get into the woods, or you're just in your yard and you've got deer, squirrels or any species with fur, the chances of ticks are very real."
"When you don't have an explanation with a person with neurologic or psychiatric symptoms, you need to not say it's all in their head," he says. "There may be an underlying organic illness, and one of those we're seeing more and more is Lyme disease. We may not be able to diagnose, but we put them on the antibiotic, and they get better."
Most people do respond well to the standard treatment, which is four to six weeks of intravenous antibiotic therapy, experts say. And sometimes the results are startling, Fallon says.
"There are cases of people I've met with full-blown dementia that was reversed with appropriate medication," Fallon says