BORRELIOOSIN OIREITA LAPSILLA

[Bb]

Lähettäjä: Soijuv Lähetetty: 28.3.2004 11:51

Borrelioosia sairastavat lapset saattavat oireilla mm. seuraavasti: mielialanvaihteluja, ärtyisyyttä, vihanpurkauksia, päänsärkyä, uupumusta, unettomuutta, keskittymiskyvyn puutetta jne. Oireet ovat tuttuja myös monille borrelioosia sairastaville aikuisille.


Brian Fallon, M.D.
Associate Professor of Clinical Psychiatry
Columbia University College of Physicians and Surgeons
Director, Lyme Disease Research Program
New York State Psychiatric Institute
1051 Riverside Drive, #69
New York, NY 10032

Neuropsychiatric Lyme Disease in Children and Adults
Brian Fallon, M.D.*, Felice Tager, Ph.D. Ron Rykiel, Ph.D.
Columbia University, New York State Psychiatric Institute, and the Jackson School District, NJ

While encephalopathy is not recognized in the CDC's Surveillance Case Definition of Lyme disease, cognitive disturbance due to Lyme Disease is common in adults and accounts for much of the long-term disability. Psychiatric disturbances, such as changes in mood, anxiety, paranoia, mania, psychosis, also may emerge during Lyme disease, in some cases as a reaction to having a serious disabling illness and, in other cases, as an organically induced disorder which improves when appropriate antibiotic treatment is given. Recently, published reports indicate that children also may have severe neuropsychiatric problems related to Lyme disease. This talk will review current knowledge about neuropsychiatric Lyme disease in adults and children, focusing upon one recent controlled study of neuropsychiatric problems in children with Lyme disease.

Methods 22 children with Lyme disease and 27 healthy age- and sex-matched controls between the ages of 8 and 18 were recruited. Measures of psychopathology included the Child Behavior Checklist (parent and child form), the DuPaul Attention Deficit Hyperactivity Disorder Rating Scale, the Child Depression Inventory, and a comprehensive neuropsychiatric symptom checklist. In addition, parents and children with Lyme disease were interviewed using the Diagnostic Interview Schedule for Children to obtain DSM Axis I disorders.

Results The children with Lyme disease were ill for over 3 years (mean 39.9 months). The mean time between symptom onset and diagnosis was 10.5 months. Nearly two-thirds had received IV antibiotics in addition to oral antibiotic treatment. Among the ongoing symptoms endorsed by over 70% of the Lyme children, the majority were neuropsychiatric (irritability, rage reactions, mood swings, depression, headache, poor concentration, memory loss) and systemic (fatigue, arthralgias, insomnia). Each symptom was reported significantly more frequently by the Lyme sample than the controls. 50% of the children with Lyme disease reported suicidal ideation and 9% reported having made a suicide gesture. After controlling for multiple comparisons, the Lyme children had significantly more anhedonia (CDI), more inattentiveness (DuPaul), and more internalization and externalization (CBCL). On the DISC child interviews, the most common diagnoses were disturbances of: mood (major depression 55%, systhymia 15%); fear (panic disorder 20%, separation anxiety disorder 20%, overanxious disorder 20%); cognition (Attention Deficit Hyperactivity Disorder 25%); and behavior (Oppositional Defiant Disorder 25%, Conduct Disorder 20%).

Discussion These results suggest that neuropsychiatric problems occur among children with chronic Lyme disease, particularly since the majority of parents reported that these neuropsychiatric problems were new-onset after contracting Lyme Disease. The frequency rates of neuropsychiatric disorders are not generalizable to all children with chronic Lyme disease given the likelihood of referral bias affecting our study. Nevertheless, these findings should alert clinicians and educators to the need to consider Lyme disease when faced with a child from a Lyme endemic area who has new onset neuropsychiatric and systemic symptoms.