Lyme Disease Presents Diagnostic Challenge to Psychiatrists

Syphilis, caused by the spirochete bacterium Treponema pallidum, has been called the “great imitator” because of its ability to affect numerous systems and be confused with other diseases. At a workshop at APA’s 2013 annual meeting titled “Medical Conditions Mimicking Psychiatric Disorders Versus Psychiatric Disorders Mimicking Medical Conditions: Diagnostic and Treatment Challenges,” presenter Yu Dong, M.D., Ph.D., a psychiatry resident at Baystate Medical Center in Springfield, Mass., detailed the case of another spirochetal imitator: Borrelia burgdorferi, the Lyme disease bacterium. Dong shared with a packed room her case of a 19-year-old female college sophomore who suffered neuropsychiatric manifestations of early stage Lyme disease. The patient’s symptoms of anxiety, migraine headache, and sleep disturbance first manifested shortly after she was bitten by a tick in the summer of 2012, but it would be early 2013 before her Lyme disease diagnosis was made. The patient’s initial enzyme immunoassay for evidence of antibodies against Borrelia burgdorferi was negative, and Lyme disease was not diagnosed until early 2013, with a Western blot test. Lyme disease is rare, and neuropsychiatric manifestations of it are even rarer, said Dong, but symptoms may become permanent and irreversible without treatment, making recognition imperative.