2002]No. 2A PSYCHIATRIC AND COGNITIVE FEATURES OF LYME
Meeting of the American Psychiatric Association
Psychiatric and neuropsychological aspects of Lyme Disease
Thursday, May 18, 2002
Felice A. Tager, Ph.D., Department of Psychiatry, Columbia
University, 622 West 168th Street, Box 427, New York, NY 10032; Brian A. Fallon,
Objective: This presentation will review the
published literature on the psychiatric and neuropsychological aspects of Lyme
disease. The goal is to help mental health clinicians by
- describing the
psychiatric and neuropsychological symptoms typical of Lyme disease and
- analyzing laboratory tests that are useful in confirming or supporting the
All studies found through MEDLINE and PsycINFO
(1970ópresent) focusing on cognitive and psychiatric aspects of Lyme disease
Reports from Europe and the United States suggest
that psychiatric symptoms, e.g.,
- anxiety, and
- mood swings,
may be prominent characteristics of Lyme disease. In addition, impairments in
- language, and
- motor functioning
adults with late-stage Lyme disease.
Patients with disseminated
Lyme disease may present with psychiatric and cognitive problems including
disturbances of memory, attention, mood, and sleep. Psychiatrists in areas where
Lyme is endemic will be referred such patients, sometimes before the disease has
been diagnosed. Clinicians need to be aware of the range of features associated
with Lyme disease in order to aid in the differential diagnosis and care of
SYMPOSIUM 2óPLAGUES, PRIONS, AND PARANOIA: THE NEUROPSYCHIATRY
OF INFECTIOUS DISEASE
Issue Workshop 6 BLAMING THE PATIENT: BLIND SPOT FOR
DOCTOR AND PATIENT
Chairperson: David R. Coursin, M.D., 6-D Hills Ave, Concord,
Participant: Douglas B. Coursin, M.D.
OBJECTIVES:At the conclusion of this workshop, the participant should be able to
1) identify "blaming the patient" from a perspective that is, itself, less
blaming, 2) identify basic concepts of contemporary evolutionary theory, 3)
apply them to an understanding of social behaviors that generate stigmatization
of mental illness, 4) critically examine a grass-roots plan addressing
stigmatization in our communities.
SUMMARY:"Blaming the patient" is a dynamic
placing clinicians and patients at risk. We will examine its evolutionary
origins, yielding insights into the maleficence it creates in all medical
specialties and the stigmatization it generates toward the mentally ill.
presentation of a patient's case of neuroborreliosis demonstrates this dynamic
complicating the doctor-patient relationship. It compromises accurate
self-assessment by the patient and puts blinders of suspicion on clinicians
addressing her prominent symptoms without convincing findings.
exercises engage group participation through the use of the Wason Card-Sorting
Task to demonstrate adaptive problem-solving, the byproduct of which is the
cognitive blind-spot where "blaming the Patient" hides. Later exercises will
critique a plan to combat this face of stigma by organizing a nationwide
coalition of psychiatrists, lawyers, legal aid agencies, law students, and
psychiatric residents. The plan aims to identify and coordinate local
psychiatric resources willing to provide live psychiatric testimony in cases of
working people seeking compensation for mental illness. This is one of the
places where stigmatization occurs right under our noses every day. Fair hearing
in such cases is too often denied by "blaming the patient" and insuring
availability of live psychiatric testimony is an untapped opportunity for our
REFERENCES:1. Fallon BA: Lyme disease: a neuropsychiatric
illness, Am J Psychiatry 1994; 151:1571-1583.
2. Barkow JH, Cosmides L, Tooby
J: The Adapted Mind: Evolutionary Psychology and the Generation of Culture. New
York, Oxford University Press, 1992.
2000]NR683 Thursday, May 18, 12:00 p.m.-2:00 p.m. Fluvoxamine
Treatment of Hypochondriasis
Altamash I. Qureshi, M.D., Department of Psychiatry, Columbia
University, 1051 Riverside Drive, #69, New York, NY 10032; Brian A. Fallon,
M.D., Michael R. Liebowitz, M.D., J. Arturo Sanchez-Lacay, M.D.
Background. Because SSRIs may be a particularly effective
treatment for hypochondriasis, we explored the efficacy of
Methods. 18 patients with DSM-IV hypochondriasis entered. All
received placebo for 2 weeks and fluvoxamine for 10 weeks starting at 50 mg/day
and increasing to 300 mg/day. Ratings included SCID-I and -II, patient-rated
measures (Analog scale, Whiteley Index [IAS], MOS Short-Form 36), and
physician-rated measures (CGI, HIC Severity Scale, and a modified Y-BOCS).
Responder status was defined by physician-rated CGI improvement of at least
"much improved". Minimum treatment required at least 6 weeks of
Results. Among the 18 patients, 4 were dropped during the 2-week
placebo run-in. Among the 14 patients given active medication, 3 discontinued
before week 6. Of the remaining 11 patients, 8 (72.7%) were responders. One
non-responder was later identified as having Lyme disease. Detailed results from
the various ratings will be presented.
Discussion. The CGI responder rate
from this fluvoxamine trial (72.7% for the minimum treatment analysis and 57.1%
for the intent-to-treat analysis) was comparable to the results reported
previously for fluoxetine. Fluvoxamine therefore appears to be an effective
treatment for hypochondriasis. A controlled trial is needed.
Version:27. Mai 2002
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