NEUROPSYCHIATRIC LYME ASSESSMENT
See Article - Neuropsychiatric Assessment of Lyme Disease

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+ Symptom/syndrome present 1st Col. Premorbid Baseline
+/- Sub-syndromal 2nd Col. Present in course of illness
- Symptoms not present 3rd Col. Initial Visit
? Unknown 4th Col. Subsequent visits, etc.
O Not applicable or available
* High diagnostic significance
# Uncommon symptoms
DB1 - Database of NPLD patients pre-infection
DB2 - Database of NPLD patients post infection
 

 

Patient Name:  

Date of Birth:

Current Age:

Date:

Date of Infection:

Date of LD Diagnosis:

Date Treatment Started:

History Exposure to Endemic Area:

History of Tick Bite:

History Erythema Migrans Rash:

With Flu-Like illness

Recurrent Erythema Migrans Rash:

Lab Findings:

 

Other Diagnoses Considered:

 

 

Pre-Existing Psychiatric Illness:

 

 

Pre-Existing Physical Illness:

 

Cognitive Symptoms

Attention Span (Perception)

Sustained Attention

Allocation of attention

Distracted by Frustration

Distracted by Hyperacuity

*Auditory

Visual

Tactile

Olfactory

Memory

*Working Memory

*Working Spatial Memory

Recent Memory

Remote Memory

Encoding Errors

Memory Retrieval

*Slowness of retrieval

Words

Numbers

Names

Faces

Motor sequences

Geographical/Spatial

*Sequential Memory

Letter reversals

Spelling errors

Word substitution errors

Number reversals

Processing

*Reading comprehension

*Auditory comprehension

Sound localization

Transposition of laterality

*L-R confusion

Visual imagery

*Calculation

*Fluency of speech

*Stuttering

*Slurred speech

*Fluency of written language

*Handwriting

*Spatial perceptual distortions (microscopia, etc)

Decreased body awareness

Derealization

*Optic ataxia

Agnosia

Apraxia

 

Imagery

Complex imagery

*Intrusive images

Aggressive

Sexual

Other

Hypnagogic Hallucinations

Vivid nightmares

Illusions

Hallucinations

 

Thought Processes / Exec function

Unfocused concentration

*Fuzzy/Fog sensation

*Prioritizing multiple tasks

*Concentration on multiple tasks

Racing thoughts

Obsessive thoughts

Mental apathy

Abstract reasoning

 

Mood Symptoms

Decreased frustration tolerance

Sudden abrupt mood swings

Hypervigilance

Paranoia

 

Behavioral Symptoms

Disinhibition

Exaggerated startle reflex

Explosive anger

Suicidal

Homicidal

Accident prone

Decreased social functioning

Decreased job/school performance

Marital/family difficulties

Substance abuse

Legal difficulties

Dissociative episodes

Compensatory compulsions

Dropping objects

Crying spells

 

Psychiatric Syndromes

Depression

*Rapid Cycling Bipolar

Panic Disorder

Obsessive-Compulsive disorder

Social phobia

Generalized anxiety

PTSD

 

Oscillating Rhythms

Impaired sleep wakefulness cycle

Not well rested in the a.m.

Insomnia

Initial

Mid

Late

Hypersomnia

Loss of 24 hour cycle

Narcolepsy

 

Eating Disorder

Anorexia

Weight loss

Non-appetite motivated

Over-eating

Weight gain w/o increased food intake

Weight gain with increased food intake

Sexual

*Decreased libido

Menstrual irregularity

Decreased capacity for pleasure

Other

 

Temperature Control

Body Temperature Fluctuations

Flushing

Intolerance to heat

Intolerance to cold

Decreased body temperature

Low grade fevers

Night sweats

Chills

 

Neurological

Headaches

*Cervical Radioculopathy

Migraine

Orgasm Migraine

TMJ

Tension

Cluster

Sinus

 

Cranial Nerves

I. Olfactory, loss of smell, altered taste

II. Ophthalmologic

Blurred vision

*Photophobia

Bright Light

Fluorescent and flicker

Floaters

Flashes

*Conjunctivitis

Eye pain

Dry eyes

Papilledema

Blind spots

Night blindness

Peripheral shadows

Other

III, IV, VI double vision or eye drifts when tired

Ptosis

V. Sensory loss

*VII. Bell's Palsy

*VIII. Tinnitus

Hearing loss

Dizziness

Vertigo

Motion sickness

Tullio's

IX, X Episodic loss of speech

Choking on food, difficulty swallowing

XI. SCM and trap pain and paresis

XII.

Seizures

Grand Mal

*Complex partial

 

Other Neurological

Numbness

Tingling

Sensory loss

Burning

Static electric sensation

Crawling sensation under the skin

Stabbing sensation

Paresis

Tremor

Twitching

Muscle tightness

Muscle discomfort

Myoclonic jerks

Torticollis

#Myotonia

#EPS

Ataxia

Fainting

Herniated disks

Spasticity

Rhomberg

Other

 

Other Physical Symptoms

Joint

Pain, swelling, tightness (specify joints)

Bone thinning/fractures

*Bone pain (tibia, ribs, iliac crest, sternum, clavicle, elbow etc)

Plantar fascitis

Chronic fatigue syndrome

Fibromyalgia

Myalgia

Chondritis (ear, nose, costochondral)

Tendonitis

Carpal Tunnel

 

Cardiac

Heart block

MVP

Racing pulse

Episodes of rapid and slow HR

Pericarditis

Cardiomyopathy

Murmur

Hypertension

Hypertensive crisis

 

Pulmonary / Upper Respiratory

Shortness of breath

Cough

Sore throats

Swollen glands

Asthma

 

Gastrointestinal (GI)

Upper GI distress

Non ulcerative dyspepsia

Irritable bowel

#Hepatitis

#Pancreatitis

#Inflammatory bowel

#Cholecyctisis

#Gall stones

 

Genitourinary (GU)

Genital pain

Breast pain, tenderness

Lactation

Irritable bladder

#Atrophy of genitalia

Anesthesia of genitalia

Autoimmune symptoms
 

Other

Alcohol intolerance

Hair loss

Thyroid dysfunction

Wilson's Syndrome

Adrenal insufficiency

Hypoglycemia

Vasculitis

Ankle edema

Tooth pain

Nose bleeds

MCS

Allergies

Splenomegaly

Ecchymosis

Chronic pain

ACA

Lymphocytoma

 

Fluctuations of Symptoms

*Herxheimer reaction

*Progression of symptoms

*Symptoms fluctuation throughout the day

Stress increases symptoms

Infectious disease increase symptoms

28 day cycle or longer

Perimenstrual relapse

Episodic relapse

Antibiotics reduce symptoms

Babesiosis screen

Severe headaches

Sweats

Chills

Severe fatigue

Severe muscle ache

Afternoon fever

Ehrlichiosis screen

Decreased white count

Decreased platelet count

Elevated lever enzymes

Splenomegaly

Treatment

Psychiatric

Medical

Oral antibiotics

IM & IV antibiotics

Other/Status/Comments