Special - Letter to the Editor JAMA, referencing the
neuropsychiatric symptoms of Lyme disease.
A co-worker said she was having some weird symptoms. Several months later, she
complained of numbness, sharp pains, etc. Her doctor diagnosed her with the usual-carpal
tunnel, "nerves," etc. Her mental status started going downhill. She had many of
the same symptoms I have with Lyme disease. I kept telling her to go back to her doctor.
Then headaches started, and they stayed. Another doctor did a CAT scan and an MRI of her
head which revealed a tumor. She had a year to live. She never had an objective symptom. I
saw alot of things, why couldn't her doctor? Others thought her symptoms were from
"stress." They wanted her to see a counsellor. It made me cry. In the end, she
could hardly sit up in her chair. She would sit sort of hunched over, like she was falling
foreward. I am not an alarmist, but why assume something is stress? Why are so many
medical people looking for "objective" signs when so many things obviously do
not have objective signs? Why do tumors and Lyme do the same thing?
I also wanted to comment on the treatment of depression with Lyme. I didn't know that
your body worked that way. It makes sense now to treat the depression so that your body
can work on the disease itself. Could this mean that a person could be depressed first,
didn't know it, and that is why their body could not fight the disease, or any other
disease for that matter?
This is a sad, but appropiate case to emphasize the subjective/objective issue.
Brain tumors are sometimes a very difficult diagnosis, particularly when they present
with cognitive or psychiatric symptoms. In one such case, the presenting symptom
was-"I looked at my family doctor and his face changed to something that looked like
a combination of Perer Lorrie and Raymond Massey." Eventually a temporal lobe tumor
In another case, the only complaint was that it was taking longer and longer to
complete his work. The cause was lung cancer metastasized to the parietal lobe. Another
patient with depression, mood swings, subtle cognitive impairment, and decreased judgement
had a frontal lobe tumor.
The diagnosis of problems like these require a knowledge of both psychiatry and general
medicine, and even then, medicine is still an imperfect science. There has been both panic
from over diagnosis, and tragedies from under diagnosis. Sir William Osler, the father of
American medicine, once stated-"If you listen long enough, the patient will give you
A critical point is that subjective symptoms, even when considered bizarre, diffuse,
and non-specific should be adequately explained. It is an error to label anything not
proven by a test as "psychosomatic"or malingering. Psychosomatic illness is
never a diagnosis of exclusion, instead it follows very clear, life long patterns in a
There is currently a strong pressure in medicine to prove everything with some type of
laboratory test. When reliable tests do not exist, we need to resort to the more basic
skill of a thorough history, a thorough exam, and sound clinical judgement. In regard to
the depression issue, there is alot of interesting research in this area recently. The
conclusion is- treating depression significantly improves physical health. Some of the
areas studied most include AIDS, gynecological cancers, and cardiac disease. In short,
stress pre-empts other bodily functions such as the ability to fight disease.
Robert Bransfield MD
The diagnosis and treatment of any
medical and / or psychiatric disorders requires trained medical professionals. The
information provided is to be used for educational purposes only. It should not be used as
a substitute for seeking professional care for the diagnosis and / or treatment for any
medical and / or psychiatric disorder.