First Symptoms Of Chronic Lyme Disease Often Are Psychiatric In Nature
By Virginia T. Sherr, MD Poster presented at the Lyme Disease Foundation's 14th International Scientific Conference on Lyme Disease, 2001
Objectives: Five patients who sought help for major personality changes and who later reported physical symptoms were selected from an adult psychiatry private practice near Philadelphia in PA, USA, evaluated via Western Blot antibody tests and, in two cases, PCR blood tests for possible borrelia DNA. No patient was previously suspected of having Lyme disease but while in psychotherapy each described symptoms compatible with chronic LD. All had recent onset of cognitive deficits, and new episodic irritability. Neither joint swelling nor other "typical" Lyme symptoms were prominent at the time of initial work up for Lyme disease (LD) and other tick-borne diseases (TBDs). Patients were tested to ascertain if TBDs could be causing or complicating their mental/emotional symptoms and, if so, would antibiotic treatment help. No patient was aware of having had a tick bite or bull's eye rash.
Rationale: Ticks infect humans with viruses, smaller parasites grid bacteria, some or all of which eventually may exert noxious influences on the victim's neural/cognitive systems. Patients may have resultant personality changes but no awareness of causative underlying infections. When multi-system symptoms appear and if the nature of their illness is unrecognized, patients may describe themselves to psychiatrists as "hypochondriacs" or "complainers". Careful testing of such patients in endemic areas often reveals clear evidence of neuro-Lyme disease (spirochetal neuroborreliosis).
Method: Five outpatients, who originally considered themselves well physically but who had manifested notable personality changes, eventually began to describe symptoms of chronic Lyme disease. Four tested positive by the Center for Disease Control Western Blot IgG antibody criteria of 5 or more positive bands and 1 tested positive by IGeneX Ref. Lab WB criteria. The latter patient's test had 4 CDC positive IgG LD bands plus a positive band #34. The two PCR-tested cases were positive for the DNA of the causative spirochete.
Results: When these neuro-Lyme patients were treated with appropriate antimicrobial medications for extended periods of time, most physical symptoms were reversed completely in every case. One patient was restored psychologically without the use of any psychotropic medication; the others retained lesser, residual emotional/mental symptoms, requiring intermittent or regular use of psychotropic drugs. Major cognitive symptoms slowly resolved with antibiotics. Modafinil or methylphenidate helped by relieving mental fog/excessive sleepiness; zolpidem or mirtazapine ended the insomnia.
Conclusions: Greater understanding of the diverse effects of disseminated spirochetal disease should prove helpful to physicians in their evaluation of anxious, irritable, depressed patients whose brain function and cognitive abilities may be distorted by microbes. Achieving such diagnostic skills allows psychiatrists to test, then to arrange for and support appropriate medical referrals for on-going antimicrobial treatment of these widely epidemic, personality-altering, tick-borne infections. Sophisticated history taking and lab testing are recommended. It is important to note that some patients with or without PCR positive tick-borne diseases will test sero-negative on early examinations but usually will convert to positive WB testing as antimicrobial treatment progresses over time and they are able to make appropriate antibodies.