children_Canon_Berenbaum.pdf

Lyme Disease - a Psychotherapy Perspective

by Lynne Canon, CSW-R , BCD and Sandy Berenbaum, CSW-R, BCD

From Lyme Times #32, Winter 2001/Spring 2002, pp.17-18.

Much has been written about the medical side of Lyme Disease, making resources on diagnosis and

treatment available to the medical practitioner. The psychiatric and cognitive manifestations have been

documented, as well. However, little has been written to encourage the psychotherapist to appreciate

the role he or she can have in reaching a diagnosis, or treating a diagnosed Lyme patient.

The psychotherapist has a unique opportunity to see Lyme Disease in a different way, through the

reports of the behaviors, mood, and cognitive functioning of the individual who seeks treatment. By

writing this, our hope is that it will encourage psychotherapists to learn more about Lyme, and to

promote dialogue between the medical and mental health practitioners regarding diagnostic and

treatment strategies, with collaboration and coordinated treatment planning.

We have seen many undiagnosed Lyme Disease patients in our office over the past 10 years. For the

majority, our office was the first place they heard that their problems might be connected with a

medical illness. For some, they had psychiatric or psychotherapeutic treatment, in some cases,

inpatient, for years before coming to Family Connections. Our referrals to medical practitioners for a

Lyme disease evaluation have been, for the most part, accurate, with good to excellent outcome

following coordinated medical and mental health treatment.

Mental health practitioners who practice in Lyme-endemic areas need to have a comprehensive

knowledge of the illness, including an awareness of the difficulties with diagnosis. That can be

accomplished through conference attendance, literature searches (there are some fine web sites), and

conferring with medical professionals who are Lyme disease specialists, and who have had good

treatment outcomes with chronic Lyme patients. It’s also important to maintain a personal library of

resources, to keep informed of new developments in this field where new information is emerging

constantly.

Of primary importance is the effect that Lyme disease can have on the brain, with just about any

psychiatric presentations: mood disorders, psychosis, bipolar disorder, eating disorders, attentional and

cognitive problems (see articles by Brian Fallon, MD, and Marion Rissenberg, PhD, among others).

Lyme disease patients may use drugs or alcohol, to self-medicate the physical pain, depression, or

anxiety . An adolescent may be brought for treatment for behavior problems, school phobias or very

poor school performance, conflicts with the family, or just about anything else a psychotherapist sees

in an adolescent-focused practice. We have seen, in our Lyme-endemic area, that Lyme may well be the

cause, or a factor, with many of these adolescents. If, in fact, it is a part of the picture, little

improvement occurs until there has been a medical diagnosis, and treatment has begun.

Below is a Lyme disease screening protocol we have developed. If Lyme is suspected, a referral should

be made to a Lyme-literate physican as soon as possible.

Berenbaum-Canon Lyme Disease Screening Protocol

1. History of changes in:

• behavior at home, school, or in other settings

• school performance or attendance

• sleeping and eating patterns

• socialization patterns, or dramatic change in peer group

• mood

• depression

• anxiety

• temper flare-ups

• suicidal ideation or gestures

• intensification of PMS

2. History of changes in activity level, that could be suggestive of Lyme disease.

Sudden loss of interest or inability to participate in activities such as organized

sports, music, dance, drama, youth group, etc.

3. A discreet point in time at which problems began

4. History of onset of other psychiatric symptoms (panic attacks, hallucinations,

attentional problems not present in early childhood)

5. History of use of psychiatric medications, with either no success symptom

reduction or a paradoxical response

6. History of any physical illness (flu, mononucleosis, bronchitis) occurring prior to

start of psychiatric, learning or behavioral problems

7. History of short term antibiotic treatment for medical problem (strep infection,

etc.) with temporary improvement of symptoms

Given that so many youngsters with Lyme have, at the very least, attentional problems, understanding

diagnostic issues and treatment options for ADD and AD/HD can be very helpful. Mental health

practitioners who are working with children and adolescents can avail themselves of continuing

education in these areas. CHADD (Children and Adults with Attention Deficit Disorder), for example,

sponsors a fine conference annually on ADD and AD/HD.

Many young Lyme Disease patients require school accommodations to succeed. It is therefore

important that mental health practitioners become familiar with special education laws, as well as

Section 504 of the Civil Rights Act, so that they can engage with parents and school personnel in the

development of a school plan (IEP or 504 plan) that will promote maximum functioning for Lyme

disease patients. The Disabilities Law Center at Albany Law School offers an excellent annual training

conference, usually in June.

Family Connections Center for Counseling began 15 years ago, as a private practice, utilizing an

innovative co-therapy approach to treating adolescents and their parents. Our treatment method was

designed for work primarily with high-risk adolescents, with psychiatric or substance abuse diagnoses

or behavioral problems. The goal of our practice has always been to improve the functioning of

adolescents, to keep them from long-term inpatient and residential facilities, and to help their parents

provide the supports and structure they needed, despite a history of dysfunction and/or trauma.

We never anticipated that a medical illness would produce the variety of psychiatric and family

problems that we have seen in Lyme patients and their families, particularly when Lyme is chronic, or

has not yet been diagnosed. Given the complexities of the illness, and the effects on the patient and

family, many chronic Lyme disease patients and their families benefit significantly from a

comprehensive, collaborative approach to treatment of both the Lyme disease, and the

psychopathology and family problems that can accompany it. We hope this article encourages further

development of multi-modal strategies and treatment plans.

Lynne Canon, CSW-R, BCD amd Sandy Berenbaum, CSW-R, BCD

Family Connections Center for Counseling

Dutchess Medical Arts Building

1323 Route 9 - Suite 101A

Wappingers Falls, N.Y. 12590

(914) 297-

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