Archive for the ‘Psychological Aspects’ Category

Psychiatric Manifestations of Tick-Borne Infections: Dr. Bransfield

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March 12, 2021

Online Seminar: Robert Bransfield on Psychiatric Manifestations of Tick-Borne Infections

This online seminar took place on Friday 12 March 2021 and was facilitated by Julia Knight, our Press & Community Outreach Manager. Dr Bransfield discussed Lyme disease and tick borne infections from a psychiatric perspective and how these illnesses affect brain chemistry.

Dr Bransfield’s primary activity is an office based private practice of psychiatry. He is the Associate Director of Psychiatry and Chairman of Psychiatric Quality Assurance at Riverview Medical Center in Red Bank, NJ, Past Immediate President of the International Lyme and Associated Diseases Society, and Immediate President of the New Jersey Psychiatric Association.

Dr Bransfield has kindly shared his presentation with us, which is available for download here: Robert C Bransfield Chronic Neuropsychiatric Symptoms from Lyme/Tick-Borne Disease and COVID-19.

More by Dr. Bransfield:

Pilot Study Finds Evidence of Bartonella in Schizophrenia Patients

https://news.ncsu.edu/2021/03/pilot-study-bartonella-schizophrenia-patients/

Pilot Study Finds Evidence of Bartonella Infection in Schizophrenia Patients

NC State gateway at sunset
FOR IMMEDIATE RELEASE

A pilot study from North Carolina State University and the University of North Carolina at Chapel Hill has found evidence of Bartonella infection in the blood of people with schizophrenia and schizoaffective disorder.

“Researchers have been looking at the connection between bacterial infection and neuropsychiatric disease for some time,” says Dr. Erin Lashnits, a former veterinary internist at NC State, current faculty member at the University of Wisconsin and first author of the study.

“Specifically, there has been research suggesting that cat ownership is associated with schizophrenia due to the zoonotic parasite Toxoplasma gondii, but to date there has been no conclusive evidence in support of a causative role for this parasite. So we decided to look at another cat-associated infectious agent, Bartonella, to see if there could be a connection.”

Bartonella are bacteria historically associated with cat-scratch disease, which until recently was thought to be solely a short-lived (or self-limiting) infection. Cats can become infected with Bartonella via exposure to fleas and potentially ticks, which are natural vectors of the bacteria. The cat is a host for at least three of the 40 known Bartonella species: Bartonella henselae, Bartonella clarridgeiae and Bartonella koehlerae.

“While there is emerging understanding of neuropsychiatric illnesses such as schizophrenia as disorders of brain networks, the question about the actual causes remains unanswered,” says corresponding author Flavio Frohlich, associate professor of psychiatry at the UNC School of Medicine. “It was an exciting opportunity for us in the UNC Department of Psychiatry to team up with the leading experts on Bartonella to pursue this innovative idea of a potential link to schizophrenia. To our knowledge, this is the very first work that examines a potential role of Bartonella in schizophrenia.”

The research team enrolled a group of 17 people with stable, medically managed schizophrenia or schizoaffective disorder, and a control group of 13 healthy adults, to test for evidence of Bartonella infection.

All participants filled out questionnaires on severity of symptoms and potential Bartonella exposure. Blood samples were taken from participants twice in a one-week period. The samples were cultured in a growth medium, and both cultured and whole blood samples underwent qPCR and droplet digital, or ddPCR testing, at seven-, 14- and 21-day intervals, to look for evidence of Bartonella organism-specific DNA. Blood samples were also tested for Bartonella species-specific antibodies.

Of the 17 patients with schizophrenia, 12 had Bartonella DNA in their blood, as compared to only one of 13 in the control group. According to the questionnaires, both patients and controls reported similar pet ownership and flea exposures.

Bartonella ddPCR, a very new diagnostic technology, provides a more sensitive molecular test than we’ve previously had access to,” says Dr. Ed Breitschwerdt, Melanie S. Steele Distinguished Professor of Internal Medicine at NC State and study coauthor. “If we had not used ddPCR to test this cohort of individuals, we would not have found Bartonella DNA in any of the participants, either case or control.”

“It is important to remember that our study was by design not able to demonstrate a causal link between Bartonella infection and schizophrenia,” Frohlich says. “However, we believe this initial observational study strongly supports the need for follow-up research.”

The researchers plan to proceed with a larger study to see whether their preliminary results are borne out.

“Many of these patients have been undergoing care for years,” Breitschwerdt says. “What we’re starting to see is a pattern – Bartonella can persist for a long time. And for the subset of people who can’t eliminate the infection, the bacteria can cause chronic or progressive illness.”

The research appears in Vector Borne and Zoonotic Diseases and was supported in part by the National Institutes of Health (grants UL1TR002489 and T32OD011130). Ricardo Maggi and Julie Bradley of NC State, as well as L. Fredrik Jarskog of UNC-Chapel Hill, contributed to the work.

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Note to editors: The abstract of the paper follows.

“Schizophrenia and Bartonella spp. infection: a pilot case-control study”

DOI: 10.1089/vbz.2020.2729

Authors: Erin Lashnits, Ed Breitschwerdt, Ricardo Maggi, Julie Bradley, North Carolina State Univerity; L. Fredrik Jarskog, Flavio Frolich, University of North Carolina at Chapel Hill
Published: March 15, 2021 in Vector-Borne and Zoonotic Diseases

Abstract:
Recently, infections with emerging zoonotic bacteria of the genus Bartonella have been reported in association with a range of central nervous system (CNS) symptoms. Currently, it remains unknown if Bartonella spp. infection is associated with symptoms of schizophrenia/schizoaffective disorder (SCZ/SAD). The objective of this study was to determine if there is an association between Bartonella species infection and SCZ/SAD. A secondary objective was to determine if SCZ/SAD symptoms were more severe among participants with documented Bartonella spp. infection. Using a case–control study design, 17 cases and 13 controls were evaluated with a series of clinical and cognitive assessments. Blood samples were collected and tested for Bartonella spp. infection using serological, microbiological, and molecular techniques. People with SCZ/SAD were more likely than healthy volunteers to have Bartonella spp. DNA in their bloodstream, with 11 of 17 cases (65%) positive by Bartonella spp. droplet digital PCR (ddPCR). In comparison, only one healthy volunteer was Bartonella spp. ddPCR positive (8%, p = 0.0024). Based on serology, Bartonella spp. exposure was common among people with SCZ/SAD (12 of 17) as well as among healthy volunteers (12 of 13), with no significant difference between the groups ( p = 0.196). Within the case group of people with SCZ/SAD, there was no significant difference in SCZ/SAD severity scores between people with and without ddPCR evidence of Bartonella spp. infection. This pilot study provides preliminary evidence in support of future investigations that should examine a potential contribution of Bartonella spp. infection to SCZ/SAD.

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Beating the Winter Blues

https://globallymealliance.org/beating-the-winter-blues/

By Jennifer Crystal

In the best of times, late winter can drag for people. Cabin fever and a longing for sunshine and warmth make us feel like we’re in the movie Groundhog Day, repeating the same scene over and over and over. The pandemic has only made the usual winter blues worse. We’ve already been repeating the same isolated days, with many people working or learning from home, for a year.

Now the dismal weather makes it seem like this period will never end.

This is a feeling that tick-borne illness patients understood long before the pandemic.

For many patients, especially those with late-stage Lyme disease, days, months, and even years blend together into a bedridden monotony. As I explained in my post “Groundhog Day: Casting a Shadow on Lyme Disease”, for several years my own life revolved around sleeping, taking medications, and going to the pharmacy or doctor’s appointments. Every day was the same, with symptoms sometimes improving and sometimes getting worse. I didn’t know if it was Monday or Wednesday. There was no differentiation between weekdays and weekends. Battling Herxheimer reactions, brain fog, burning extremities, systemic hives, headaches, and aching muscles and joints, I wondered if the suffering would ever end.

At times, the monotony was worse than the symptoms themselves. Staring at the same walls, interacting with the same people (or experiencing total isolation if you live alone), not being able to do your usual activities, can make a person want to scream. Sometimes, I did scream. Sometimes I still do.

But surviving tick-borne illness has taught me some important lessons for getting through the pandemic, as I outline in my posts “What Lyme Patients Can Teach Us About the New Normal” and “Lessons From Lyme: Lockdown Isn’t Forever”. My illness journey also gave me some tools for getting through long, isolating winters. Below are some ideas for beating the winter blues during a pandemic:

Change your scenery: This may seem easier said than done when you’re stuck at home. Sometimes, though, we make ourselves more stuck than we need to be. I mostly convalesced in my bedroom. Even moving to the couch could be a welcome change of scenery. Try working in a different room in the house, taking a walk in a different direction each day, or even eating at a different seat at the kitchen table. A small shift in scenery can make a big shift in perspective.

Redecorate: Whether you order a new comforter, knit a new blanket, or paint a wall a new color, a change in scenery, rather than just a change of scenery, can be refreshing. If you are a caretaker for a Lyme patient, think about ways you can do some redecorating for them (with their permission, of course).

Keep some routine: Part of the difficulty of the pandemic is many people feel their days are unstructured. When I was sick, the day dragged most when there was nothing to do but just lie in bed. Once I started to get a bit better, I appreciated having a set routine of physical therapy twice a week, neurofeedback twice a week, talk therapy once a week, etc. Now, Zoom meetings and remote or hybrid schooling give at-home workers or students some semblance of a schedule, but it’s not always enough. Having set meal times, stretch breaks, or reading hours can lend more structure to an otherwise open-ended day. Think about fun routines that can give you something to look forward to as well: weekly Zoom game nights with friends, pizza nights with the family, or home manicures.

…and also add some variety to that routine: Variety is the spice of life, even when you’re stuck in bed or at home. If you’re able, try a new type of exercise once or twice a week. Watch a new show. Try a new recipe (or, if you’re took sick to cook, have a caretaker make one for you). Paint your nails a wild color. Novelty breaks up monotony and helps you feel like you’re controlling some aspect of an otherwise uncontrollable situation.

Get outside: I know it’s cold. I know it’s dreary. I know you might not feel well enough to exercise (and you shouldn’t, if you’re sick with tick-borne illness and aren’t ready). If you are able, think about trying a new winter sport like snowshoeing. Build a snow fort, no matter how old you are. If you feel awful, perhaps just sit on a front stoop or back porch for five minutes in a mask. Or open the window for five minutes.

Be cozy: Hibernation doesn’t have to mean huddling inside miserable. Make yourself as comfortable as possible. Try a weighted blanket. Put on fuzzy socks and slippers. Make some hot tea. Pampering yourself is part of self-care, and self-care is a critical part of healing and survival.

Sunbathe: You don’t have to be on a beach, or even outside, to soak up some rays. Think like a cat: find a sunny patch of couch or floor in your house, and curl up there, pointing your face to the light. You might even set up a beach chair inside and soak your feet in a bucket of water to pretend you’re at the beach. When I was sick, I took these “staycations” indoors. Now, I have scoped out a sunny, isolated spot in my neighborhood where I sit at lunch time. Vitamin D is healing!

Listen to sounds or watch images of nature: If you’re too sick to get outside, or you live in a city where you can’t do so in a socially distanced manner, you can still reap the benefits of nature virtually. Nature sounds calm the nervous system. Just listening to a soundtrack of a waterfall or birds chirping, or looking at images of mountains, can help elicit the feelings you would have while actually experiencing nature.

Talk to someone outside your pod: No matter how much you love the people you live with, being home with them all the time can be stifling. It’s hard to make time for phone calls when you’re managing a family, working from home, or feeling too sick to talk for long. But even carving out ten minutes per week to talk to an old friend can be revitalizing.

And finally, the most important lesson I learned from my journey with Lyme is that spring always does come, no matter how long the winter lasts.

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jennifer crystal_2

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at lymewarriorjennifercrystal@gmail.com.

Could Cytokine Storms Lead to Brain Fog in Lyme Disease Patients?

https://danielcameronmd.com/cytokine-brain-fog-lyme-disease/

COULD CYTOKINE STORMS LEAD TO BRAIN FOG IN LYME DISEASE PATIENTS?

brain-fog-lyme-disease

Lyme disease and COVID-19 patients often complain of having ‘brain fog.’ In a recent study, Remsik and colleagues suggest that brain fog reported by COVID-19 patients may be due to cytokines rather than an infection with the coronavirus SARS-CoV-2.

In their article, published in the journal Cancer Cell,¹ the authors explain, “One of the dozens of unusual symptoms that have emerged in COVID-19 patients is a condition that’s informally called ‘COVID brain’ or ‘brain fog.’ It’s characterized by confusion, headaches, and loss of short-term memory. In severe cases, it can lead to psychosis and even seizures.”

The authors expected to find evidence of COVID-19 infection in the cerebral spinal fluid (CSF) of 13 patients hospitalized with COVID-19. They did not.

Instead, Remsik and colleagues found an elevation of cytokines in the spinal fluid of their COVID-19 patients with brain fog. According to the authors, “These patients had persistent inflammation and high levels of cytokines in their cerebrospinal fluid, which explained the symptoms they were having.”

“These increased CSF cytokines are likely the result of both increased blood barrier permeability and local production by cells in the CNS,” the authors write.

Investigators have previously raised concerns that Lyme disease spirochetes could cross the blood-brain barrier leading to brain fog. In his article, Dr. Robert Bransfield raised concerns that persisting immune activation causes a cytokine storm in patients with chronic Lyme disease.²

Remsik et al. add support to the role of cytokines in patients with brain fog, leading to the question: Are cytokine storms associated with brain fog in Lyme disease patients?

References:
  1. Remsik J, Wilcox JA, Babady NE, et al. Inflammatory Leptomeningeal Cytokines Mediate COVID-19 Neurologic Symptoms in Cancer Patients. Cancer Cell. Feb 8 2021;39(2):276-283 e3. doi:10.1016/j.ccell.2021.01.007
  2. Bransfield RC. The psychoimmunology of lyme/tick-borne diseases and its association with neuropsychiatric symptoms. Open Neurol J. 2012;6:88-93. doi:10.2174/1874205X01206010088

16-Year-Old Boy With Lyme Disease Presenting as Depression

https://danielcameronmd.com/16-year-old-boy-lyme-disease-presenting-depression/

16-YEAR-OLD BOY WITH LYME DISEASE PRESENTING AS DEPRESSION

Adolescent with Lyme disease and depression holding his head

There has been increasing research linking COVID-19 with the development of neuropsychiatric symptoms, including depression and anxiety. But multiple studies have already found an association between other infections, such as Lyme disease, and the onset of depression.

 

One study found a high prevalence of depression in Lyme disease patients. Between January 2008 and December 2014, 1 in 5 patients treated at the Lyme Center Apeldoorn in the Netherlands was diagnosed with depression and Lyme disease. ¹

Meanwhile, Dr. Robert Bransfield, a psychiatrist specializing in the diagnosis and treatment of tick-borne illnesses, reports “In my database, depression is the most common psychiatric syndrome associated with late-stage Lyme dis­ease.

I estimate that there are at least 1,200 people per year who commit suicide as the result of Lyme disease,”  Bransfield writes in his article “Suicide, Lyme and Associated Diseases.” ²

Borrelia burgdorferi, the causative agent of Lyme disease, “may be diagnosed as a persistent infection with immune suppressant and evasive capabilities or there may be a postinfectious process,” Bransfield writes. “In either case, the psychiatric symptoms are associated with an immune-mediated process.

Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University, describes the case of a 16-year-old adolescent who presented with long-standing depression, which suddenly worsened.³

Neuropsychiatric symptoms

He reported anger, frustration, insomnia, poor appetite, mild weight loss, and passive suicidal ideation. He would say, “I wish I could just die in my sleep.”

The boy complained of brain fog and had a steep decline in cognitive abilities. His symptoms were initially presumed to be caused by “either laziness or mild depression.” He suffered from ongoing knee pain and was forced to quit sports.

His grades dropped from “A’s” in 7th grade to nearly failing by 10th grade. He suffered from fatigue and forgetfulness. “He appeared lazy because he found it hard to get out of bed in the morning,” Fallon writes.

The boy’s symptoms were extensive and included:

• severe headaches
• facial fasciculations, myalgias
• stiff neck
• hyperacusis
• episodic paresthesias of his face and hands
• sudden sweating
• painful joints
• sore throats
• palpitations
• electric shock-like pains
• word-finding problems, such that it was hard to finish sentences
• semantic paraphasias
• short-term memory problems, such that he could not recall conversations
• testicular pain

Since he reported having embedded ticks in the past, Lyme disease was clinically diagnosed “given the suspicious clinical history.”

His Lyme ELISA results were negative twice in the prior 3 months, but his IgG Western blot revealed 4 of the 5 requisite CDC specific bands. A brain SPECT revealed findings consistent with encephalitis, vasculitis, and Lyme disease.

Treatment response

The boy was diagnosed with probable Lyme encephalopathy and treated with 12 weeks of intravenous ceftriaxone.

He improved on sleep, appetite, headaches, joint pains, numbness, distractibility, short-term memory, and emotional behavior. His depression cleared without the need for antidepressant medications. His IQ improved by 22 points, and his school performance markedly improved.

References:
  1. Zomer, T.P., et al., Depressive Symptoms in Patients Referred to a Tertiary Lyme Center: High Prevalence in Those Without Evidence of Lyme Borreliosis. Clin Infect Dis, 2017. 65(10): p. 1689-1694.
  2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587. Published 2017 Jun 16. doi:10.2147/NDT.S136137.
  3. Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703, viii.

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**Comment**

If there was ever a great example of the importance of Lyme/MSIDS being clinically diagnosed, this is it!

This poor teenager would have continued spiraling down until he might just have achieved his wish of dying.  

This study points out a number of things parents and doctors should be considering:

  1. The plethora of symptoms that suggest a systemic infection(s)
  2. The drop in grades
  3. The stiff neck (few things cause this – but it’s hallmark for Lyme)
  4. The fact antibiotics helped so many of the symptoms – including the depression – without any antidepressants
  5. He was seronegative – and so many are.  Doctors have to stop relying upon testing to diagnose this and must become more educated on tick-borne illness.
The CDC just upped numbers again from 300,000 to 476,000 new cases of Lyme diseases per year – highlighting the fact this plague is serious, isn’t going away, and something needs to be done about it.

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We can be thankful he fell into the hands of Dr. Fallon or this young man would most probably not had a favorable outcome.