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NEW YORK, NY, OCTOBER 24, 1997 -- Researchers at Columbia-Presbyterian Medical Center have demonstrated that brain scans and neuropsychiatric tests can help doctors determine whether psychiatric problems are due to Lyme disease or a primary psychiatric disorder.

The findings are important since many people with Lyme disease do not exhibit the classic rash and flu-like symptoms but later experience secondary symptoms such as depression, panic attacks, paranoia, personality changes, mood swings, attention problems, or short-term memory loss. These symptoms can be easily mistaken for primary psychiatric disorders, especially the when patient's clinical presentation does not include joint swelling or Bell's palsy, two of the more commonly recognized signs of Lyme disease, and when standard laboratory tests for the disease prove inconclusive, which is not infrequently the case in chronic Lyme disease.

"Such mislabeling may have particularly detrimental effects on the Lyme disease patient, as a delay in diagnosis and treatment may result in a curable acute infection becoming a chronic, treatment-refractory illness," writes study leader Brian Fallon, MD, Associate Professor of Clinical Psychiatry at Columbia-Presbyterian, in a recent issue of Clinical Infectious Diseases.

In an earlier study, Dr. Fallon found that depression was three times more common in patients with Lyme disease than in patients with comparable diseases (lupus, rheumatoid arthritis, and osteoarthritis). "That was surprising to us, and it suggested that there is something going on in the brain of Lyme patients that is directly causing the depression," he says.

Dr. Fallon, in collaboration with Ronald Van Heertum, MD, and Jeffrey J. Plutchok, MD, and their colleagues in the Divison of Nuclear Medicine, Department of Radiology, subsequently found that at least half of patients with chronic Lyme disease have brain abnormalities, evident on SPECT (single photon emission computed tomography) scans. "The specific appearance is a heterogeneous pattern of decreased perfusion," says Dr. Fallon, who is also Director of the Lyme Disease Research Program at the New York State Psychiatric Institute. "What that means is that across the brain, there are patchy areas that look like decreased blood flow. However, we don't know whether it is a vascular problem or a metabolic problem. But what is clear is that it is a diffuse problem."

In a follow-up study, the researchers found that blood flow to the affected areas of the brain improved in approximately half of the patients who were given intravenous antibiotic treatments. This result suggested that the brain abnormalities were at least partially reversible with further treatment.

Since this pattern of decreased brain perfusion is seen in patients with other diseases, including HIV encephalopathy, chronic cocaine abuse, chronic fatigue syndrome, and lupus, SPECT imaging alone cannot be used to confirm a diagnosis of chronic Lyme disease. According to Dr. Fallon, a thorough evaluation should include a physical examination and standard laboratory tests, plus formal neuropsychological testing (e.g., the Wechsler Memory Scale) and brain imaging (MRI, SPECT, or PET scanning).

When should a doctor suspect that a neuropsychiatric problem is the result of Lyme disease? According to Dr. Fallon, "If the only thing a patient has is depression or anxiety, Lyme disease would be low on the list of possibilities," he says. "But if he or she has mood swings, attention problems, or memory problems, as well as some joint pains and some numbness and tingling, you have to consider Lyme disease, especially in the greater New York area, where it is endemic. And anytime you see a young patient with memory problems, then you have to start wondering, could this be Lyme disease?"

Dr. Fallon's latest findings were published this summer in Clinical Infectious DiseasKeywords: PSYCHIATRY PSYCHIATRIC PSYCHIATRIST MENTAL HEALTH PHYSICIAN BRAIN STIGMA

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