Proposed Lyme Disease Guidelines and Psychiatric Illnesses

Abstract

The Infectious Disease Society of America, American Academy of Neurology, and American Academy of Rheumatology jointly proposed Lyme disease guidelines. Four areas most relevant to psychiatry were reviewed—the disclaimer, laboratory testing, and adult and pediatric psychiatric sections. The disclaimer and the manner in which these guidelines are implemented are insufficient to remove the authors and sponsoring organizations from liability for harm caused by these guidelines. The guidelines and supporting citations place improper credibility upon surveillance case definition rather than clinical diagnosis criteria. The guidelines fail to address the clear causal association between Lyme disease and psychiatric illnesses, suicide, violence, developmental disabilities and substance abuse despite significant supporting evidence. If these guidelines are published without very major revisions, and if the sponsoring medical societies attempt to enforce these guidelines as a standard of care, it will directly contribute to increasing a national and global epidemic of psychiatric illnesses, suicide, violence, substance abuse and developmental disabilities and the associated economic and non-economic societal burdens. The guideline flaws could be improved with a more appropriate disclaimer, an evidence-based rather than an evidence-biased approach, more accurate diagnostic criteria, and recognition of the direct and serious causal association between Lyme disease and psychiatric illnesses.

Monitoring of Nesting Songbirds Detects Established Population of Blacklegged Ticks and Associated Lyme Disease Endemic Area in Canada

“…When biofilm busters are implemented prior to blood draw, they help to activate the immune response and provide more reliable serological testing [107]. Psychiatric illnesses, caused by Bbsl, may include violence, substance abuse, and developmental disabilities [108][109][110]. Chronic Lyme disease frequently causes severe disability, and potentially gives rise to central nervous system complications and cognitive impairment [49,50,61,90].…”

“…Chronic Lyme disease frequently causes severe disability, and potentially gives rise to central nervous system complications and cognitive impairment [49,50,61,90]. Under the dire duress of chronic Lyme disease, patients resort to suicide [108][109][110], and critically ill patients ultimately have fatal outcomes caused by advanced Bbsl spirochetosis [68,71,73,88,111,112]. Bbsl may be potentially transmitted to a partner via intimate relations [89,113].…”

Detection and Transstadial Passage of Babesia Species and Borrelia burgdorferi Sensu Lato in Ticks Collected from Avian and Mammalian Hosts in Canada

“…Often, patients advance to chronic Lyme disease before they get diagnosed and treated. Psychiatric illness, caused by Lyme disease, may include violence, substance abuse, and developmental disabilities [130][131][132]. Lyme disease may cause severe and potentially fatal central nervous system complications.…”

“…Fatal neurological impairments include seizures, grand mal seizures, chronic meningoencephalomyelitis, massive hypocephalus, epilepticus, ependymitis, progressive encephalitis, cerebral atrophy, periventricular white matter disease, and irreversible brain injury [133][134][135]. When the pathologies of neuroborreliosis are unrelenting, the pain in musculoskeletal tissues is unbearable, and somnolence is unending, Lyme disease patients sometimes resort to suicide [130][131][132]. Ultimately, this severely debilitating illness can be fatal [12,116,117,119,[133][134][135].…”

Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty

“…The IDSA is in the process of revising these guidelines in 2019, and a draft of its guidelines was posted briefly for public comment. The revised guidelines showed little change in most of the areas of controversy, and attention to some of the flaws in the proposed guidelines has been addressed [50][51][52].…”