Hassett Afton L, Radvanski Diane C, Buyske Steven, Savage Shantal V, Gara Michael, Escobar Javier I, Sigal Leonard H
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
Arthritis Rheum. 2008 Dec 15;59(12):1742-9. doi: 10.1002/art.24314.
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 Lyme disease).
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.
评估慢性莱姆病（CLD）患者中精神疾病共病及其他心理因素的患病率和作用。
我们从一个在学术性莱姆病转诊中心接受评估的240名患者队列中选取了159名患者进行评估。对患者进行常见的轴I精神疾病（如抑郁和焦虑障碍）筛查；通过结构化临床访谈确诊。还评估了轴II人格障碍、功能状态以及消极和积极情绪及疼痛灾难化等特质。一名对精神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以及那些有归因于莱姆病但无伯氏疏螺旋体感染的医学无法解释症状的患者）与两组非CLD患者（从莱姆病中康复的患者以及那些有可识别的医学状况解释归因于莱姆病症状的患者）进行比较。
在调整年龄和性别后，CLD患者中轴I精神疾病比对照患者更常见（P = 0.02，比值比2.64，95%置信区间1.30 - 5.35），但人格障碍并非如此。与对照患者相比，CLD患者有更高的消极情绪、更低的积极情绪以及更大的疼痛灾难化倾向（P < 0.001）。除人格障碍外，所有心理因素均与功能水平相关。基于这些心理变量的预测模型得到了证实。46.8%的CLD患者被诊断为纤维肌痛。
精神疾病共病及其他心理因素使CLD患者有别于莱姆病转诊中心常见的其他患者，且与功能不良结局相关。
