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To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic
Lyme disease (CLD).
We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic
Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-
Lyme disease syndrome and those with medically unexplained symptoms attributed to
Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from
Lyme disease and those with an identifiable medical condition explaining symptoms attributed to
After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients.
Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in
Lyme disease referral centers, and were related to poor functional outcomes.