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Lyme neuroborreliosis does not seem to boost psychiatric risk

JAMA Psychiatry
Reuters Health - 13/10/2020 - Lyme neuroborreliosis was not associated with a higher risk of developing psychiatric disease requiring hospitalization or prescription medication in a matched cohort study in Denmark.

"The increased use of anxiolytics, hypnotics, sedatives and antidepressants was somewhat surprising," Malte Tetens of Copenhagen University Hospital told Reuters Health by email. "However, as we analyzed the data, it became clear that part of this increased medication might be explained by management of neuropathic pain following diagnosis."

As reported in JAMA Psychiatry, the study included 2,897 patients (56.8% men) with Lyme neuroborreliosis diagnosed from 1995-2015 and 28, 970 matched controls. The median age was 45.7 years.

Compared with controls, Lyme disease neuroborreliosis patients had no higher risk for developing psychiatric diseases overall (HR, 1.1) or any subcategory of psychiatric disease - i.e., mental and behavioral disorders owing to psychoactive substance use (HR, 1.0); schizophrenia (HR, 0.8); mood/affective disorders, HR, 1.2; anxiety, HR, 1.5; obsessive-compulsive disorders, HR, 0.6; and reaction to severe stress and adjustment disorders, HR,1.1.

Nevertheless, as Dr. Tetens indicated, a higher percentage of Lyme neuroborreliosis patients received anxiolytics (7.2% vs. 4.7%), hypnotics and sedatives (11.0% vs. 5.3%), and antidepressants (11.4%vs 6.0% within the first year after diagnosis, after which the receipt of psychiatric medication returned to the same level as the comparison cohort.

Tetens said, "Many questions remain unanswered, especially if and why there is an increased use of anxiolytics, hypnotics, sedatives and antidepressants. Nonetheless, our study is reassuring for the affected patients and serves as a counterweight to anecdotes suggesting that psychiatric disease is caused by Lyme neuroborreliosis."

"Further," he added, "we must emphasize that our study focuses on patients with Lyme neuroborreliosis and was not designed to evaluate the prevalence of post-treatment Lyme disease syndrome."

Dr. Timothy J. Sellati, Chief Scientific Officer at the Global Lyme Alliance, Inc. in Stamford, Connecticut, commented in an email to Reuters Health, "The significantly increased prescription of psychiatric medication during the first year after diagnosis does suggest that there were psychiatric symptoms that needed to be treated during that first year. While it is true that some may have been prescribed for pain, that is an assumption or a hypothesis whose validity should be tested in a future study."

"Future studies should also investigate the prevalence of suicidal behaviors or cognitive disorders, and the full cohort of Lyme disease manifestations, not just neuropathologies," he said.

"It may also be informative to have a community-based follow-up after a hospital Lyme neuroborreliosis diagnosis using standardized psychiatric measures," he noted. "We don't know whether or not a psychiatric diagnosis was made in these patients during the year after Lyme neuroborreliosis diagnosis because many would have been followed up...by community-based physicians - not in the hospital outpatient clinic."

That said, he concluded, the fact that increased medication use was not found beyond one year after a Lyme neuroborreliosis diagnosis, "is a good indication that there are no long-term sustained psychiatric problems after Lyme neuroborreliosis."

By Marilynn Larkin

SOURCE: https://bit.ly/350SLj4 JAMA Psychiatry, online October 7, 2020.

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