title: Screening for Lyme disease in hospitalized psychiatric patients: prospective serosurvey in an endemic area.
abstract: BACKGROUND
  Nervous system involvement in Lyme disease may mimic certain psychiatric disorders. We studied whether it is worthwhile to conduct routine screening of psychiatric inpatients for serologic evidence of Lyme disease.
  
  
  METHODS
  Between March 1988 and June 1989, we prospectively screened sera for Lyme disease from adults admitted to an acute care psychiatric hospital in Westchester County. New York, an area in which this infection is endemic. Of all cases of Lyme disease reported to the U.S. Public Health Service in 1988, 16% originated in Westchester County. The prevalence in healthy blood donors from this area were reported to be 0.7%. Sera were tested by fluorescent immunoassay alone (90%) or fluorescent immunoassay plus enzyme-linked immunosorbent assay (10%).
  
  
  RESULTS
  Sera from only 1 of 517 patients demonstrated antibodies to Borrelia burgdorferi, the etiologic agent of Lyme disease (0.2% [95% CI, 0.0% to 1.1%]). This patient had a nonreactive Western blot, which suggested a false-positive antibody test.
  
  
  CONCLUSIONS
  We cannot presently recommend routine serologic screening for Lyme disease for adult psychiatric inpatients, even in areas of the United States where this illness is endemic.
authors.affiliation: Department of Medicine, New York Medical College, Valhalla, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: E
authors.initials: E
authors.lastname: Herman
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D004797:Enzyme-Linked Immunosorbent Assay; D006778:Hospitals, Psychiatric; D006801:Humans; D007118:Immunoassay; D007297:Inpatients; D008193:Lyme Disease / Q000175:diagnosis* / Q000453:epidemiology; D001523:Mental Disorders / Q000175:diagnosis*; D009518:New York / Q000453:epidemiology; D011446:Prospective Studies; D016036:Seroepidemiologic Studies