Psychiatric Implications for Lyme Disease / Dr. Robert Bransfield

By Cynthia Chase

Untreated or delayed treatment of Lyme disease or coinfections can lead to spirochete involvement in the brain. Some researchers believe that bacteria may migrate to the brain even early on in the infection.

Many psychiatric and neurological conditions can manifest in degrees ranging from mild to severe. It is critical that treating professionals and patients themselves understand that this medical condition may be at the bottom of clinical manifestations of conditions such as depression, anxiety, panic attacks, mood swings that may mimic bi-polar disorder, sleep disorders, Attention Deficit Disorder, Autism-like disorder, rage and impulse disorders, psychosis, seizures and cognitive losses.

Dr. Robert Bransfield, a Lyme-literate psychiatrist from Red Bank, New Jersey has developed an amazing and comprehensive neuropsychiatric evaluation. What makes it ground-breaking is that he understands what happens to the brain and mind from the inside-out. He tracks common neurological and psychiatric conditions that can be associated with Lyme and associated illnesses.

This is not a blaming, as in “It’s all in your head.” This is a validation and understanding that bacterial invasion into the body and brain can produce unusual and unexpected effects that color the way we feel, sense and experience the world.

By discretely and in a detailed way tracking the inner world, he allows the patient to understand how these strange and seemingly unconnected pains, feelings, thoughts and experiences are tied to a physical illness that demands healing – not just one-dimensional medical treatment.

Here is a description of Dr. Bransfield’s evaluation:

Cognitive symptoms that are commonly associated with Lyme disease and other coinfections are associated with:

A. Attention span:

• Is sustained attention possible?
• Can attention be prioritized and allocated in an effective way?
• Is attention easily distracted by frustration?
• Is attention distracted by excessive sensitivity to auditory stimulation?
• Is attention distracted by visual stimulation?
• Is attention distracted by tactile stimulation?
• Is attention distracted by olfactory stimulation?

B. Memory

• Can information be kept in the mind long enough to complete problem solving?
• Can awareness be maintained of structures in surrounding space?
• Can information be recalled that was learned in prior years?
• Is information stored correctly in the mind?
• Is memory retrieval slow when retrieving:
  1. word
  2. numbers
  3. names
  4. faces
  5. motor sequences
  6. geographical and spatial data

• Is there a decreased ability to spell correctly?
• Is there a tendency to reverse the sequence of letters in words?
• Is there a tendency to insert opposite, closely related or incorrect words in a sentence?
• Is there a tendency to reverse numbers when writing a number?

C. Processing

• Is there a decrease in the ability to understand what is read?
• Is there a significant decline in the ability to understand spoken language?
• Is the ability to track where a sound is generated from reduced?
• Is the ability to track spatial awareness of the environment reduced?
• Is there an increased difficulty targeting movements through space (for example, bumping into doorways)?
• Is there a loss in the ability to rotate something 180 degrees in your mind?
• Is there a tendency to confuse left and right?
• Have calculation abilities declined?
• Does speech flow fluently, or is there a tendency to it to be interrupted?
• Has stuttering increased?
• Is speech slurred at times?
• Can thoughts be put down in writing, or has that ability declined?
• Has handwriting deteriorated?
• Is there at times a feeling of loss of connection with physical existence?
• Is there a loss of the feeling of reality?
• Is there a loss in the ability to recognize familiar objects?
• Is there a loss in the ability to perform skilled tasks?

D. Imagery

• Is there a loss in the ability to visualize an image in your head?
• Do images intrude that may be aggressive, sexual or in other ways disturbing?
• Is there a tendency to dream even when awake?
• Is there a tendency for vivid nightmares?
• Are objects in peripheral vision sometimes distorted?
• Is there evidence that you may hear, see, smell or feel things that are not there?

E. Thought processing and Executive Function

• Memory impairment or loss – also called Lyme fog
• Difficulty in concentrating
• Inability to absorb information
• Tangential thinking – that is, starting in one direction then going off in a different direction
• Difficulty in planning and prioritizing multiple tasks
• Difficulty in performing multiple simultaneous tasks
• Racing thoughts
• Obsessive, repetitive thoughts that cannot be controlled
• Mental apathy, or lack of spontaneous thought, ideas or initiative
• Lost ability for abstract reasoning

F. Mood Symptoms

• Decreased frustration tolerance
• Sudden abrupt mood swings
• Hypervigilance
• Paranoia

G. Behavioral Symptoms

• Lack of normal inhibition (disinhibition)
• Exaggerated Startle Reflex
• Explosive anger
• Suicidal
• Homicidal
• Accident Prone
• Decreased social functioning
• Decreased Job or school performance
• Marital or family problems
• Substance abuse
• Legal difficulties
• Dissociative episodes (feeling separate from your own self)
• Compulsive behavior to compensate for feeling of failure
• Dropping objects
• Crying spells

H. Psychiatric Syndromes

• Depression (this and all other conditions not previously experienced)
• Manic depression rapidly alternating between depression and mania
• Panic disorder
• Obsessive-compulsive disorder (not previously experienced)
• Social phobia
• Generalized anxiety

I. Maintenance of Life functions (also called Vegetative Functions)

Impaired sleep wakefulness cycle

This can vary from not feeling well-rested in the morning to initial, mid and late insomnia. It may also be that one sleeps too much (called hypersomnia) or looses the 24 hour cycle altogether.

• Eating disorder

Newly diagnosed anorexia, weight loss, or overeating not motivated by hunger; there may be weight gain with increased food intake and at times there may be weight gain even without increased food intake.

• Sexual disorders

There may be decreased or increased libido; there may be decreased capacity for arousal or orgasm or pleasure. There may be a change or alteration in sexual imagery. Menstrual irregularity may occur as well.

• Disturbed temperature control

There may be body temperature fluctuations, flushing, night sweats, low grade fevers and chill, intolerance to heat and cold.

J. Neurological Symptoms

• There may be a variety of headache types: general, cervical radioculopathy, migraine, or orgasm migraine. It is also possible to have headaches associated with TMJ (temperomanidbular joint syndrome), tension, cluster or sinus headaches.

• Cranial nerve involvement

1. Olfactory nerve

There may be loss of the sense of smell altered sensation of smell or hypersensitivity as well as altered taste.

2. Opthalmologic involvement

When this nerve is affected there may be blurred vision, aversion to light , either bright, florescent or flickering light (photophobia). There may be excess floaters, light flashes, conjunctivitis, eye pain or dry eyes. There are sometimes blind spots, night blindness, peripheral shadows, inflammation of the iris, inflammation of the uvea, optic neuritis and papilledema (swelling of the optic disc). There may be double vision or the eye may drift when tired. There may also be drooping of the upper lid.

3. Sensory Loss; what this means is that there may be areas of numbness. It can feel both without sensation, or painfully numb.

4. Bell’s Palsy (facial paralysis)

5. Ringing in the ears (tinnitus), hearing loss, dizziness, vertigo, motion sickness or sound-induced vertigo, dizziness, nausea and/or eye movements (tullio’s syndrome)

6. Episodic loss of speech, choking on food, difficulty swallowing

7. Paresis is partial loss of movement, or impaired movement. It usually refers to the limbs, but it also can be used to describe the muscles of the eyes and stomach.

8. Tongue veers off to one side

• Seizures

1. There may actually be Tonic-clonic seizures (previously called Grand Mal Seizures) which are a type of generalized electrical firing or overstimulation affecting the entire brain.

2. There may also be complex partial seizures. Complex partial seizures take place in a discrete part of the brain, usually in the temporal or cortical part of the brain and cause impaired consciousness. What this means is that there may be decreased responsiveness and awareness of the self and surroundings. It may be difficult to communicate, respond to commands or remember events. During a complex partial seizure, the patient may not communicate, respond to commands, or remember events that occurred.

• Other Neurological problems
• Numbness
• Tingling
• Sensory Loss
• Burning
• Static electric sensation
• Crawling sensation under the skin
• Stabbing sensations
• Partial loss of movement (paresis)
• Tremors
• Twitching
• Muscle tightness
• Muscle discomfort (like restless leg)
• Myoclonis – brief, shock-like jerks of muscle or group of muscles.jerks of a muscle or a group of muscles.
• Torticollis, or wry neck, is a condition in which the head is tilted toward one side, and the chin is elevated and turned toward the opposite side.
• Tourette’s syndrome - that is, a complex of symptoms that include multiple involuntary muscle movements called tics, and impulsive verbal (sometimes in the form of swearing or insulting) tics.
• Ataxia, that is gross lack of coordination of muscle movements
• Fainting
• Herniated disks
• Spasticity
• Meningismus – that is an intolerance to bright light and headaches
• Musculoskeletal

The joints may be painful, there may be swelling, tightness; there may be bone thinning or fractures, bone pain, inflammation of the elbow, plantar fascitis (heel pain), muscle pain (chronic fatigue syndrome), fibromyalgia (chronic widespread pain), inflammation of the cartilage – it may turn red and be warm to the touch (of the ear and nose for example), tendinitis, carpal tunnel syndrome (painful wrist/s)

• Cardiac

Microbial involvement in the heart may manifest as chest pain, mitral valve prolapse, racing pulse, episodes of rapid and slow heart rate, inflammation of the pericardium, cardiomyopathy (that is, the heart muscle becomes inflamed and doesn’t work as well as it should), heart murmur, hypertension, or hypertensive crisis.

• Pulmonary/Upper Respiratory

Complication in this system may include shortness of breath, cough, sore throat, swollen glands, or asthma. There may be upper gastro-intestinal distress, chronic or recurrent indigestion, irritable bowel, abdominal bloating, delayed gastric emptying (the vegus nerve may be impaired, which gives direction to the intestines to promptly move digested food out of the bowel), hepatitis, pancreatitis, inflammatory bowel, inflammation of the gall bladder, gall stones or fecal incontinence.

• Genitourinary Problems

There may be genital pain, breast pain or tenderness, inappropriate lactation, irritable bladder, interstitial cystitis – this is a painful condition of the bladder, urinary incontinence, atrophy of the genitalia, numbness of the genitalia or recurrent urinary tract infections.

• Autoimmune Symptoms

Since Lyme disease affects the body’s ability to defend itself, there are a multitude of possible repercussions. Here are some of the symptoms or syndromes that can result: alcohol intolerance, hair loss, thyroid dysfunction. There may develop a syndrome called Wilson’s Syndrome which is an alternative medical diagnosis (controversial) in which the syndrome’s manifestations include fatigue, headaches, premenstrual syndrome, hair loss, irritability, fluid retention, depression, decreased memory, low sex drive, unhealthy nails, easy weight gain, and other symptoms, in the absence of a blood test indicating hypothyroidism.

A condition called adrenal insufficiency may develop in which the adrenals, located above the kidneys, do not produce adequate amounts of steroid hormones (chemicals produced by the body that regulate organ function), primarily cortisol, but may also include impaired aldosterone production which regulates sodium, potassium and water retention.Craving for salt or salty foods due to the urinary losses of sodium is common.

Hypoglycemia is a medical condition in which the blood contains lower than normal glucose levels. Hypoglycemia can produce a variety of symptoms and effects but the principal problems arise from an inadequate supply of glucose as fuel to the brain, resulting in impairment of function. Symptoms can range from vaguely “feeling bad” to coma, seizures and (rarely) permanent brain damage or death. Hypoglycemia can arise from many causes and can occur at any age.

Vasculitis may occur. This is a condition referring to destructive inflammation of the arteries and veins. Sometimes abnormal buildup of fluid is found in the ankles, feet, and legs called peripheral edema. Tooth pain and periodontal disease is sometimes associated with Lyme disease. Nose bleeds and multiple chemical sensitivities may develop along with severe allergies. Enlargement of the speen has been observed in chronic Lyme patients, and easy bruising has been observed as well. Chronic pain may be experienced in bone or muscle, or other locations, sometimes roving.

A condition called Lymphocytoma may co-occur: this is a circumscribed mass of mature lymphocytes.

The overview here is that since immune function is compromised and the body is not able to protect itself fully, many unrelated conditions may develop.