885. Evidence Against the Psychological Vulnerability Hypothesis of Post-Treatment Lyme Disease Syndrome
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Background: Lyme disease is the most commonly reported vector-borne infectious disease in North America. After antibiotic treatment, a subset of individuals report persistent symptoms associated with functional decline, termed Post-Treatment Lyme Disease Syndrome (PTLDS).  Behavioral and psychologic pathology have been hypothesized in the etiology of PTLDS. We investigate differences between patients with and without PTLDS before treatment and across time with respect to exposure to traumatic life events, their approach to coping, fatigue, pain, and depressive symptomatology.

Methods: Seventy-three patients with clinically diagnosed, early untreated Lyme disease were enrolled in a prospective cohort study. Patients were treated with 3 weeks of doxycycline and followed for six months. At each visit, a physical exam, interval history, clinical symptoms, self-administered questionnaires (McGill Pain and Beck Depression Inventories, Fatigue Severity Scale, COPE, Life events survey, SF-36) were performed. At six months post-treatment, an operationalized definition based upon the IDSA criteria for PTLDS was used to group these patients according to symptom persistence and SF-36 health function scores.  Nine patients met criteria for PTLDS (PTLDS-positive) leaving 64 patients in the PTLDS-negative group.

Results: No differences were found between PTLDS positive and negative groups based on demographics, prior life events, or type of coping, nor at time of diagnosis in the level of fatigue, pain, or depressive symptoms.  However, immediately post-treatment, PTLDS-positive had greater depressive symptoms (mean = 9.43) than PTLDS-negative (mean = 3.98; p=0.002).  At six months post-treatment, PTLDS-positive had greater fatigue (mean = 31.43) and depressive symptoms (mean = 12.00) than PTLDS-negative (fatigue mean = 16.56 p<0.001; depression mean= 1.84, p=0.012).


These findings support that there is a subset of individuals (12%) treated for early Lyme disease who experienced persistent symptoms of fatigue and depression unrelated to psychological vulnerability, such as pre-existing depression, a history of psychological trauma, or inadequate coping.

Kathleen Kortte, PhD, ABPP-CN/RP, Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, Lauren Crowder, MPH, Lyme Disease Research Foundation, Lutherville, MD and John Aucott, MD, Medicine, Internal Medicine, The Johns Hopkins University School of Medicine, Lutherville, MD


K. Kortte, None

L. Crowder, None

J. Aucott, None

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