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Mood Disorders

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A 30-year-old woman presents to the psychiatrist with a 2-month history of difficulty in concentrating, irritability, and depression. She has never had these symptoms before. Three months prior to her visit to the psychiatrist, the patient noted that she had experienced a short-lived flulike illness with a rash on her calf, but has noted no other symptoms since then until the mood symptoms began. Her physical examination was within normal limits. Which of the following is the most likely diagnosis?

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a. Neurosyphilis

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b. Chronic meningitis

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c. Lyme disease

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d. Creutzfeldt-Jakob disease

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e. Herpes simplex encephalitis

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The answer is c. (Kaplan and Sadock, p 729.) Lyme disease is characterized by a bull's-eye rash at the site of the tick bite, followed by a flu-like illness which is often short-lived and may go unnoticed. Problems with cognitive functioning and mood changes may be the first complaints seen. These include problems concentrating, irritability, fatigue, and a depressed mood. Treatment consists of a 2- to 3-week course of doxycycline, which is curative about 90% of the time. If the disease is left untreated, 60% of patients will develop a chronic condition.

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A 30-year-old woman presents to the psychiatrist with a 2-month history of difficulty in concentrating, irritability, and depression. She has never had these symptoms before. Three months prior to her visit to the psychiatrist, the patient noted that she had experienced a short-lived flulike illness with a rash on her calf, but has noted no other symptoms since then until the mood symptoms began. Her physical examination was within normal limits. Which of the following medications should be used to treat the patient?

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a. Penicillin

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b. Antiviral medication

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c. Amphotericin B

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d. Doxycycline

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e. Fluoxetine for depressed mood (ie, treat the depressed mood only)

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The answer is d. (Kaplan and Sadock, p 729.) Lyme disease is characterized by a bull's-eye rash at the site of the tick bite, followed by a flu-like illness which is often short-lived and may go unnoticed. Problems with cognitive functioning and mood changes may be the first complaints seen. These include problems concentrating, irritability, fatigue, and a depressed mood. Treatment consists of a 2- to 3-week course of doxycycline, which is curative about 90% of the time. If the disease is left untreated, 60% of patients will develop a chronic condition.

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A 37-year-old woman comes to the physician with ...

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