The woman who reportedly wandered around the lobby of New York's famous Waldorf-Astoria hotel this weekend wearing her panties over her pants, muttering to herself and carrying a gun has prompted medical experts to revisit the question of whether Lyme disease can have psychiatric manifestations.
After police charged Marilyn Michose of Danbury, Conn., with fourth-degree criminal possession of a weapon, the 46-year-old's mother told newspapers that her daughter has Lyme disease and medication she takes makes her "manic."
It was unclear whether Michose's mother was referring to medication for Lyme disease or for some other condition. Michose was taken to a hospital for psychiatric evaluation after the incident.
Lyme disease is caused by the bite of an infected deer tick. It commonly causes a skin rash, fever, headache and fatigue. Whether the disease can have psychiatric manifestations has long been a controversy in the medical community.
While they can only speculate without knowing more about Michose's case, some experts believe a percentage of patients with Lyme disease go on to develop serious problems that might affect the brain, heart, eyes and other organs.
Skeptical experts, on the other hand, say there's little scientific evidence to back up the notion that long-term psychiatric problems can develop. They say chronic Lyme disease, which can resist treatment and cause a litany of problems for many years, simply doesn't exist.
"With Lyme disease, you can develop some significant psychiatric problems," said Dr. Brian Fallon, director of Columbia University Medical Center's Lyme and Tick-Borne Diseases Research Center in New York. "Lyme disease is an infection that can spread throughout the body and when it spreads to the central nervous system, it can cause a wide variety of manifestations, such as memory problems, verbal fluency problems and sometimes in the more acute phases of brain infection, it can cause encephalitis, which is characterized by severe confusion or personality changes."
Fallon went on to say that about 15 percent of patients infected by Lyme disease who are not treated will develop neurologic problems. Symptoms usually appear in the first few weeks after the tick bite.
Such problems, however, tend to go away after treatment but Fallon said sometimes, people get worse before they get better.
But others say cases of people who develop psychiatric problems are extremely rare.
"It's not clear that there are any kind of long-term psychiatric problems associated with Lyme disease at all," said Dr. Eugene Shapiro, professor of pediatrics, epidemiology and investigative medicine at Yale University School of Medicine. "There are cases where people get meningitis and that can cause mania, but meningitis is quickly recognized and treated.
Phillip Baker, executive director of the American Lyme Disease Foundation in Lyme, Conn., said, "Although this person [Marilyn Michose] obviously has some sort of mental or behavioral problem, I don't believe it is due to Lyme disease. Reports attributing such behavior to Lyme disease -- or justifying such extreme behavior as being due to Lyme disease -- are few, exaggerated, and unsubstantiated."
Lyme disease is treated with antibiotics. Experts say there is debate about whether to treat patients with just a short-term course of antibiotics or continue the medication for several weeks or months. The Infectious Disease Society of America and other health organizations say long-term treatment with antibiotics is ill-advised because of the risk of complications. They advocate treatment for about a month.
If Michose were taking antibiotics for Lyme disease, doctors say, the drugs likely did not cause her erratic behavior.
"Conventional antibiotic treatment for Lyme disease should not have psychiatric manifestations," said Dr. William Schaffner, an infectious disease physician at Vanderbilt University School of Medicine in Nashville, Tenn. "These are well-known antibiotics that are not exceptionally strong or toxic."
The side effects of the medications might include nausea, diarrhea and, if given intravenously, complications at the intravenous site.
If the disease is caught early enough, treatment can be as short as two weeks, and complications from the disease or from the medication will probably not develop.
"When properly diagnosed and treated early," Baker of the American Lyme Disease Foundation said, "Lyme disease is easily cured by a short course of oral antibiotics that do not alter normal behavior."