jwissmille

"........A broad range of psychiatric
reactions have been associated with Lyme disease including paranoia, dementia,
schizophrenia, bipolar disorder, panic attacks, major depression, anorexia
nervosa, and obsessive-compulsive disorder. ..." This is from one of the
following abstracts.

______________________________
"... To our knowledge this is the first reported case with an exclusive
psychiatric manifestation of Lyme disease...."

Biol Psychiatry 1999 Mar 15;45(6):795

Borrelia burgdorferi central nervous system infection presenting as an organic
schizophrenialike disorder.

Hess A, Buchmann J, Zettl UK, Henschel S, Schlaefke D, Grau G, Benecke R
Department of Neurology, University of Rostock, Germany.

BACKGROUND: We report on a 42-year-old female patient who presented with a
schizophreniform disorder and complete relief of symptoms after specific
therapy. METHODS: Cerebrospinal fluid and magnetic resonance imaging findings
led to the diagnosis of Lyme disease. RESULTS: To our knowledge this is the
first reported case with an exclusive psychiatric manifestation of Lyme
disease. CONCLUSIONS: In case of first manifestation of psychotic disorder,
although neurological symptoms are lacking, Lyme disease should be considered
and be excluded by cerebrospinal fluid analysis.

PMID: 10188012, UI: 99203827


Title: Untreated neuroborreliosis: Bannwarth's syndrome evolving into acute
schizophrenia-like psychosis. A case report.
Authors: Roelcke U, Barnett W, Wilder-Smith E, Sigmund D, Hacke W
Source: J Neurol 1992 Mar;239(3):129-31
Organization: Neurologische Klinik Universitat Heidelberg Federal Republic of
Germany.

Abstract:
In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of
neuroborreliosis) follows a predictable monophasic self-limiting course. In
contrast, we report the case of a patient with an untreated
meningopolyradiculitis which evolved into acute schizophrenia-like psychosis
due to persistent infection with Borrelia burgdorferi. The psychosis resolved
within 1 week of treatment with ceftriaxone. This case shows that the usually
benign monophasic meningopolyradiculitis may progress to severe CNS
complications, which may have implications on current pathophysiological
beliefs.

Keywords:
Acute Disease, Antibodies, Bacterial, CF, Borrelia burgdorferi, IM, IP, Case
Report, Ceftriaxone, TU, Chronic Disease, Diagnosis, Differential,
Encephalitis, CF, CO, DT, MI, Human, IgG, CF, Lyme Disease, CF, CO, DT, PX,
Male, Meningitis, CF, CO, DT, MI, Middle Age, Organic Mental Disorders,
Psychotic, CF, DI, ET, Polyradiculitis, CO, DT, MI, Schizophrenia, DI,
Syndrome, Medline File

Language: German

Title: [Endogenous paranoid-hallucinatory syndrome caused by Borrelia
encephalitis]
Authors: Barnett W, Sigmund D, Roelcke U, Mundt C
Source: Nervenarzt 1991 Jul;62(7):445-7
Organization: Psychiatrische Universit:atsklinik, Heidelberg.

Abstract:
We describe a case with no neurological signs but marked psychiatric symptoms
induced by borrelia burgdorferi, whose clinical picture was indistinguishable
from an endogenous schizophrenia. The symptoms within one week under antibiotic
treatment with ceftriaxon, but afterwards the patient showed a mild organic
brain syndrome. The case demonstrated the aetiologic nonspecificity of paranoid
symptoms and hallucinations and emphasizes that in psychotic patients without
psychiatric history additional diagnostic measures should be performed.

Keywords:
Brain Damage, Chronic, DIAGNOSIS, PSYCHOLOGY, Case Report, Diagnosis,
Differential, Encephalitis, DIAGNOSIS, PSYCHOLOGY, English Abstract, Human,
Lyme Disease, DIAGNOSIS, PSYCHOLOGY, Male, Middle Age, Neuropsychological
Tests, Schizophrenia, Paranoid, DIAGNOSIS, PSYCHOLOGY, Syndrome

Language: Ger

Unique ID: 92018508

Title: Lyme disease: a neuropsychiatric illness.
Authors: Fallon BA, Nields JA
Source: Am J Psychiatry 1994 Nov;151(11):1571-83
Organization: Department of Psychiatry, College of Physicians and Surgeons,
Columbia University, New York.

Abstract:
OBJECTIVE: Lyme disease is a multisystemic illness that can affect the central
nervous system (CNS), causing neurologic and psychiatric symptoms. The goal of
this article is to familiarize psychiatrists with this spirochetal illness.
METHOD: Relevant books, articles, and abstracts from academic conferences were
perused, and additional articles were located through computerized searches and
reference sections from published articles. RESULTS: Up to 40% of patients with
Lyme disease develop neurologic involvement of either the peripheral or central
nervous system. Dissemination to the CNS can occur within the first few weeks
after skin infection. Like syphilis, Lyme disease may have a latency period of
months to years before symptoms of late infection emerge. Early signs include
meningitis, encephalitis, cranial neuritis, and radiculoneuropathies. Later,
encephalomyelitis and encephalopathy may occur. A broad range of psychiatric
reactions have been associated with Lyme disease including paranoia, dementia,
schizophrenia, bipolar disorder, panic attacks, major depression, ANOREXIA
nervosa, and obsessive-compulsive disorder. Depressive states among patients
with late Lyme disease are fairly common, ranging across studies from 26% to
66%. The microbiology of Borrelia burgdorferi sheds light on why Lyme disease
can be relapsing and remitting and why it can be refractory to normal immune
surveillance and standard antibiotic regimens. CONCLUSIONS: Psychiatrists who
work in endemic areas need to include Lyme disease in the differential
diagnosis of any atypical psychiatric disorder. Further research is needed to
identify better laboratory tests and to determine the appropriate manner
(intravenous or oral) and length (weeks or months) of treatment among patients
with neuropsychiatric involvement.

Keywords:
Case Report, Comorbidity, Diagnosis, Differential, Female, Human, Lyme Disease,
DIAGNOSIS, EPIDEMIOLOGY, Male, Nervous System Diseases, DIAGNOSIS,
EPIDEMIOLOGY, Neuropsychological Tests, Organic Mental Disorders, DIAGNOSIS,
EPIDEMIOLOGY, Prevalence, Recurrence, Support, Non-U.S. Gov't, United States,
EPIDEMIOLOGY

Language: Eng

Unique ID: 95030026


Country: China,Nei Menggu
Abstract journal details: 2T09604Language: ChOther info: 8 ref.
Authors affiliation: Central Hospital of Forestry Industry, Greater Xing-An
Mountains, Nei Menggu, 022150, China.CABICODES: VV200

Abstract:
A serological survey to detect antibodies against Borrelia burgdorferi was
carried out in 134 cases of schizophrenia and 90 normal control subjects by IFA
in Nei Menggu, China. The results revealed that positive antibody detection was
38.9% in schizophrenics, much higher than in the control group, and
spirochaetes were isolated from a patient with schizophrenia. This indicated
that B. burgdorferi may be an aetiologic agent of schizophrenia (chronic
neurologic manifestations).Descriptors:
Lyme disease,antibodies,Borrelia burgdorferi,serological surveys,man,human
diseases,schizophrenia,nervous system diseasesAbstract no: 990500358
____________________________

REPOST

From "Lyme Disease: A Neuropsychiatric Illness" by Brian A. Fallon, MD, MPH,
and Jenifer A. Nields, MD (Am J Psychiatry, 1994; 151:1571-1583)

Excerpted from article abstract:

"A broad range of psychiatric reactions have been associated with Lyme disease
including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks,
major depression, ANOREXIA NERVOSA, and obsessive-compulsive disorder.
Depressive states among patients with late Lyme disease are fairly common,
ranging across studies from 26% to 66%."

From p. 1576:

"Case reports have linked Lyme disease to a vast array of neuropsychiatric
symptoms including paranoia, thought disorder, delusions, auditory
hallucinations, olfactory hallucinations, visual hallucinations, stereotypies,
anorexia nervosa, obsessions or compulsions, major depression, disorientation,
confusion, violent outbursts, mood lability, panic attacks, mania, personality
changes, catatonia, and dementia....In three of these cases, it was not until
the onset of a psychotic disorder that the patient was brought to medical
attention....Many of the patients had abnormalities noted on EEG, CSF, or
structural brain imaging....Although all patients responded well to antibiotic
treatment, relapses occurred in several patients."

Vol 98, No. 7, July 1998 pp373-79 in the "Clinical Practice" section
titled: " Neuropsychiatric manifestations of Lyme disease" by Dr. Philip W.
Paparone D.O.

Abstract:
"Lyme disease is a multisystem illness that may affect the central nervous
system ansd subsequently produce mild to severe psychiatric disorders.
Physicians who treat patients with Lyme disease need to be aware of its
neuropsychiatric symptoms, which may emerge months to years after the initial
infection. Prompt diagnosis and effective treatment are needed to avoid the
debilitating and possiblty irrversible mental illness associated with the
neurologic involvement of this spirochetal infection. The author reviews the
neuropsychiatric manifestations of Lyme disease and provides diagnostic and
therapeutic approaches for the management of the central nervous system disease
that may cause them."
___________________________-
good website -Dr. Bransfield

http://www.mentalhealthandillness.com/lymeframes.html

_________________

APA newspaper
Letters to the editor
Bizarre Symptoms


I cannot ignore in
my work an epidemic of bizarre neurological soft signs highlighted by acute
increases in OCD, panic, rages, depression, and so on.

I am a 41-year
veteran in the field of psychiatry and a life fellow of APA, and I have never
seen anything like this before: Perhaps three dozen people of all ages in my
practice have advanced multisystem symptoms of, among others, muscle, memory,
and stomach distress, intermittent sinusitis, and neurological symptoms.
These people, many of whom I have known for years, have gone from doctor to
doctor in vain, seeking help before they finally decide they are
hypochondriacs or have the "logical" emotional signs of specific stress. In
the past, I might have agreed with them, but no longer.

The syndrome is all
too familiar: irritability (impulsive hostility) with minimal provocation,
bewildering short-term memory loss (immediate recall), transient numbness, a
brief paralysis of a limb or limbs during the night, transient tremors,
malaise, fatigue, GERD, lethargy, and sleep attacks. Unfortunately, each
specialist sees one symptom relevant to his or her specialty and misses the
big picture.

I have learned to order tests for Lyme disease, ehrlichiosis,
and babesiosis from a lab that does sensitive tests, and I am amazed to find
so many positives. Sometimes the tests are positive but of low titer;
however, regardless of titer, the patient does not recover until treated with
the proper antimicroorganism agent for a sufficient length of time.

Is
anyone else aware of the immensity of this problem?

Virginia T. Sherr, M.D.
47 Crescent Drive
Holland, Pa. 18966

From American Psychiatric Association's newsletter, "Psychiatric News"
(circulation 40,500 APA members), Sept. 18th, 1998 issue,
Letters to the Editor:

A Modest Proposal

In response to Dr. Virginia Sherr's letter in the July 3 issue about the
increase in the number of patients showing an unusual syndrome of neurological
soft signs that may be linked to Lyme and other tick-borne diseases, and in the
interest of health, public safety, and quality of life, we, as psychiatrists,
state the following:

Whereas:

1.Lyme disease and other tick-borne diseases are a serious public health
threat;

2.These often cryptic diseases are associated with a broad spectrum of mental
and other physical disorders, birth defects, and cognitive impairments that
increase the risk of accidents, violence, memory loss, disabilities, and
suffering;

3.Mental illnesses associated with these frequently unsuspected infections
include, but are not limited to, depression, phobias, obsessive-compulsive
disorders, panic disorders, aggressiveness, delusions, irritability,
suicidality, exhaustion, sexual dysfunction, sleep disorders, eating disorders,
and a broad spectrum of cognitive and neurological impairments. Findings more
common in children include autism, Tourette syndrome, attention deficit
disorder, dyslexia, lethargy, and a decline in grades, tantrums;

4.Since late-stage Lyme disease presents primarily as a neuropsychiatric rather
than an arthritic disease, psychiatrists are encouraged to become more active
in the diagnosis and treatment of Lyme disease;

5.The diagnosis of Lyme disease should take into consideration epidemiological
risk factors for disease and be based upon a thorough history, physical
findings (including neuropsychiatric), laboratory testing, and response to
antibiotic therapy. Commonly used tests include the Western Blot,
neuropsychological testing for the cognitive component, and SPECT scans. Tests
that are being used with increasing acceptance include PCR, cultures, Lyme
urine antigen test, and PET. Spinal taps are most commonly negative in the
late-stage neuropsychiatric syndrome;

6.Research on early Lyme disease has been mistakenly utilized by some insurance
companies as the standard that determines diagnostic and treatment guidelines
for late-stage Lyme disease. This position results in the inappropriate denial
of reimbursement for vital ongoing medical care;

7.We recognize the need for long-term antibiotic treatment in some of these
patients. We are concerned that financially motivated, restrictive treatment
guidelines of some of the insurance companies are harmful to patients and the
overall public welfare;

8.Public awareness, education, prevention, vaccines, early diagnosis, correct
psychiatric diagnosis, effective treatment, guidance throughout the treatment,
advocacy, and research help to reduce the seriousness of this epidemic;

9.We acknowledge and support the efforts of patients, support groups,
clinicians, researchers, drug companies, and advocates who show the commitment,
courage, and creativity to meet the challenge of tick-borne diseases;

10.In addition to tick-borne diseases, other infectious diseases and complex
interactive infectious diseases are increasingly recognized as being associated
with mental illness.

We therefore advise that:

1.An APA committee be established to better coordinate information, research,
education, policy, and guidelines in this area;

2.The name of the committee shall be the Committee on Tick-Borne and Other
Complex Infectious Encephalopathies.

Robert C. Bransfield, M.D
Red Bank, NJ

Brian Fallon, M.D., M.P.H.
[New York, NY]

Lynn Shepler, M.D., J.D.
Falmouth, MA

Virginia Sherr, M.D.
Holland, [PA]