Role of Psychiatric Comorbidity in Chronic Lyme Disease
Role of Psychiatric Comorbidity in Chronic Lyme Disease
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DOI：
10.1002/art.24314
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发表时间：
2008-12-15
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影响因子：
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通讯作者：
Sigal, Leonard H.
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文献类型：
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作者：
Hassett, Afton L.;Radvanski, Diane C.;Sigal, Leonard H.
Objective.目的探讨慢性莱姆病（CLD）患者精神共病及其他心理因素的患病率及其作用。我们评估了159例患者，这些患者来自一个学术莱姆病转诊中心评估的240例患者队列。对患者进行常见轴I精神障碍筛查（例如，抑郁症和焦虑症）;结构化临床访谈证实了诊断。轴II人格障碍，功能状态，和特质，如消极和积极的影响和痛苦灾难化也进行了评估。一名对精神病评估结果不知情的医生进行了医学评估。将两组CLD患者（莱姆病后综合征患者和莱姆病引起的医学上无法解释的症状但无伯氏疏螺旋体感染的患者）与两组无CLD患者（莱姆病恢复的患者和莱姆病引起的可识别的医学状况解释症状的患者）进行比较。在调整年龄和性别后，轴I精神障碍在CLD患者中比对照组患者更常见（P = 0.02，比值比2.64，95%置信区间1.30-5.35），但人格障碍不是。与对照组相比，CLD患者有更高的负性情感，更低的正性情感，以及更大的灾难性疼痛倾向（P < 0.001）。除人格障碍外，所有心理因素均与功能水平有关。基于这些心理变量的预测模型得到了证实。CLD患者中纤维肌痛的诊断率为46.8%。精神共病和其他心理因素将CLD患者与莱姆病转诊中心常见的其他患者区分开来，并与不良功能结局相关。
Objective. To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD).Methods. 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 Lyme disease).Results. 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.Conclusion. 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.