Neuropsychiatric Symptoms with Lyme Disease & Tick-borne Illness

0.75 CME. This course is intended to help clinicians be aware of the mental health needs and risks in patients with Lyme disease and educates on appropriate professional mental health referral, based on symptoms and clinical presentation. This concise, data-driven overview will help clinicians quickly access the latest evidence on Lyme disease persistence after standard treatments, useful in overturning the long-held belief that Lyme disease is always easy to treat and cure.

Instructor
Shannon Delaney, MD, MA
Assistant Professor, Department of Psychiatry,
Columbia University Irving Medical Center

This course is intended to help clinicians be aware of the mental health needs and risks in patients with Lyme disease and educates on appropriate professional mental health referral, based on symptoms and clinical presentation. This concise, data-driven overview will help clinicians quickly access the latest evidence on Lyme disease persistence after standard treatments, useful in overturning the long-held belief that Lyme disease is always easy to treat and cure.

Learning objectives:

  1. Monitor patients for mental health sequelae from Lyme disease 
  2. Incorporate a mental health screening tool in practice
  3. Modify practice to refer to mental health clinicians

This session, Neuropsychiatric Symptoms with Lyme Disease & Tick-borne Illness, is approved for 0.75 enduring AAFP Prescribed credits.

AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

The AAFP has reviewed One Health Medical Education for a Changing Climate, and deemed it acceptable for AAFP credit. Term of approval is from 01/02/2023 to 01/01/2024. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Evidence-based bibliography for further study

Aucott JN, Crowder LA, Yedlin V, Kortte KB. Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans. Dermatol Res Pract. 2012;2012:451727. Epub 2012 Oct 24. 

Aucott JN, Rebman AW, Crowder LA, Kortte KB. Post-treatment Lyme disease syndrome symptomatology and the impact on life functioning: is there something here? Qual Life Res. 2013 Feb;22(1):75-84

Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am 2008;22:341– 60 vii–viii. 

Weitzner E, McKenna D, Nowakowski J, Scavarda C, Dornbush R, Bittker S, Cooper D, Nadelman RB, Visintainer P, Schwartz I, Wormser GP. Long-term Assessment of Post-Treatment Symptoms in Patients With Culture-Confirmed Early Lyme Disease. Clin Infect Dis. 2015 Dec 15;61(12):1800-6. 

Shadick NA, Phillips CB, Sangha O, Logigian EL, Kaplan RF, Wright EA, et al.. Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease. Ann Intern Med. (1999) 131:919–26. 

Logigian EL, Kaplan RF, Steere AC. N Engl J Med 1990; 323:1438-1444

Rebman AW, Bechtold KT, Yang T, Mihm EA, Soloski MJ, Novak CB, Aucott JN. Front Med (Lausanne). 2017 Dec 14;4:224.

Mustafiz F, Moeller J, Kuvaldina M, Bennett C, Fallon BA. Persistent Symptoms, Lyme Disease, and Prior Trauma. J Nerv Ment Dis. 2022 May 1;210(5):359-364.

Straubinger RK, Summers BA, Chang YF, Appel MJ. J Clin Microbiol. 1997 Jan;35(1):111-6. 

Hodzic E, Feng S, Holden K, Freet KJ, Barthold SW. Antimicrob Agents Chemother. 2008 May;52(5):1728-36.

Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, Jacobs MB, Hasenkampf NR, Martin DS, Narasimhan S, Phillippi-Falkenstein KM, Purcell JE, Ratterree MS, Philipp MT. PLoS One. 2012;7(1):e29914.

Hodzic E, Imai D, Feng S, Barthold SW.. PLoS One. 2014 Jan 23;9(1):e86907.

Liegner KB, Duray P, Agricola M, Rosenkilde C, Yannuzzi L, Ziska M, Tilton R, Hulinska D, Hubbard J, Fallon B. Lyme Disease and the Clinical Spectrum of Antibiotic-Responsive Chronic Meningoencephalomyelitides. J Spirochetal and Tick-borne Dis 1997;4:61-73.

Marques A, Telford SR 3rd, Turk SP, Chung E, Williams C, Dardick K, Krause PJ, Brandeburg C, Crowder CD, Carolan HE, Eshoo MW, Shaw PA, Hu LT. Xenodiagnosis to detect Borrelia burgdorferi infection: a first-in-human study. Clin Infect Dis. 2014 Apr;58(7):937-45.

Caine JA, Coburn J. Multifunctional and Redundant Roles of Borrelia burgdorferi Outer Surface Proteins in Tissue Adhesion, Colonization, and Complement Evasion. Front Immunol. 2016 Oct 21;7:442.

Dulipati V, Meri S, Panelius J. Complement evasion strategies of Borrelia burgdorferi sensu lato. FEBS Lett. 2020 Aug;594(16):2645-2656.

Feng J, Auwaerter PG, Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline. Plos one. 2015;10(3):e0117207.

Fallon BA, Sotsky J (2018) Conquering Lyme disease: science bridges the great divide. Columbia University Press.

Chandra A, Wormser GP, Klempner MS, Trevino RP, Crow MK, Latov N, Alaedini A. Anti-neural antibody reactivity in patients with a history of Lyme borreliosis and persistent symptoms. Brain Behav Immun. 2010 Aug;24(6):1018-24.

Londoño D, Cadavid D, Drouin EE, Strle K, McHugh G, Aversa JM, Steere AC. Antibodies to endothelial cell growth factor and obliterative microvascular lesions in the synovium of patients with antibiotic-refractory lyme arthritis. Arthritis Rheumatol. 2014 Aug;66(8):2124-33.

Soloski MJ, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, Aucott JN. Serum inflammatory mediators as markers of human Lyme disease activity. PLoS One. 2014 Apr 16;9(4):e93243

Jacek E, Fallon BA, Chandra A, Crow MK, Wormser GP, Alaedini A. Increased IFNα activity and differential antibody response in patients with a history of Lyme disease and persistent cognitive deficits. J Neuroimmunol. 2013 Feb 15;255(1-2):85-91.

Aucott JN, Soloski MJ, Rebman AW, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, Bechtold KT. CCL19 as a Chemokine Risk Factor for Posttreatment Lyme Disease Syndrome: a Prospective Clinical Cohort Study. Clin Vaccine Immunol. 2016 Sep 6;23(9):757-66.

Jutras BL, Lochhead RB, Kloos ZA, Biboy J, Strle K, Booth CJ, Govers SK, Gray J, Schumann P, Vollmer W, Bockenstedt LK, Steere AC, Jacobs-Wagner C. Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis. Proc Natl Acad Sci U S A. 2019 Jul 2;116(27):13498-13507.

Schutzer SE, Angel TE, Liu T, Schepmoes AA, Clauss TR, Adkins JN, Camp DG, Holland BK, Bergquist J, Coyle PK, Smith RD, Fallon BA, Natelson BH. Distinct cerebrospinal fluid proteomes differentiate post-treatment lyme disease from chronic fatigue syndrome. PLoS One. 2011 Feb 23;6(2):e17287.

Fallon BA, Das S, Plutchok JJ, Tager F, Liegner KB, Van Heertum R (1997) Functional brain imaging and neuropsychological testing in Lyme disease. Clin Infect Dis:57–63

Pasareanu AR, Mygland Å, Kristensen Ø. A woman in her 50s with manic psychosis. Tidsskr Nor Laegeforen. 2012 Mar;132(5):537–539. doi: 10.4045/tidsskr.11.0683.

Hess A, Buchmann J, Zettl UK, et al. Borrelia burgdorferi central nervous system infection presenting as an organic schizophrenialike disorder. Biol Psychiatry. 1999;45(6):795. 

Pachner AR. Borrelia burgdorferi in the nervous system: the new “great imitator”. Ann N Y Acad Sci. 1988;539:56-64.

Hassett AL, Radvanski DC, Buyske S, Savage SV, Gara M, Escobar JI, Sigal LH. Role of psychiatric comorbidity in chronic Lyme disease. Arthritis Rheum. 2008 Dec 15;59(12):1742-9. 

Kalish RA, Kaplan RF, Taylor E, Jones-Woodward L, Workman K, Steere AC. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis. 2001 Feb 1;183(3):453-60.

Dersch R, Sarnes AA, Maul M, Hottenrott T, Baumgartner A, Rauer S, Stich O. Quality of life, fatigue, depression and cognitive impairment in Lyme neuroborreliosis. J Neurol. 2015 Nov;262(11):2572-7.

Bechtold KT, Rebman AW, Crowder LA, Johnson-Greene D, Aucott JN. Standardized Symptom Measurement of Individuals with Early Lyme Disease Over Time. Arch Clin Neuropsychol. 2017 Mar 1;32(2):129-141.

Schmidt H, Djukic M, Jung K, Holzgraefe M, Dechent P, von Steinbüchel N, Blocher J, Eiffert H, Schmidt-Samoa C. Neurocognitive functions and brain atrophy after proven neuroborreliosis: a case-control study. BMC Neurol. 2015 Aug 19;15:139.

Kalish RA, Kaplan RF, Taylor E, Jones-Woodward L, Workman K, Steere AC. Evaluation of study patients with Lyme disease, 10-20-year follow-up. J Infect Dis. 2001 Feb 1;183(3):453-60.

Doshi S, Keilp JG, Strobino B, McElhiney M, Rabkin J, Fallon BA. Depressive symptoms and suicidal ideation among symptomatic patients with a history of Lyme disease vs two comparison groups. Psychosomatics. 2018;59(5):481-489. 

Fallon BA, Madsen T, Erlangsen A, Benros ME. Lyme borreliosis and associations with mental disorders and suicidal behavior: A nationwide Danish cohort study. Am J Psychiatry. 2021;178(10):921-931. 

Fallon BA, Lipkin RB, Corbera KM, Yu S, Nobler MS, Keilp JG, Petkova E, Lisanby SH, Moeller JR, Slavov I, Van Heertum R, Mensh BD, Sackeim HA. Regional cerebral blood flow and metabolic rate in persistent Lyme encephalopathy. Arch Gen Psychiatry. 2009 May;66(5):554-63

Coughlin JM, Yang T, Rebman AW, Bechtold KT, Du Y, Mathews WB, Lesniak WG, Mihm EA, Frey SM, Marshall ES, Rosenthal HB, Reekie TA, Kassiou M, Dannals RF, Soloski MJ, Aucott JN, Pomper MG. Imaging glial activation in patients with post-treatment Lyme disease symptoms: a pilot study using [11C]DPA-713 PET. J Neuroinflammation. 2018 Dec 19;15(1):346.

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Course Includes

  • 1 Lesson
  • 2 Quizzes
  • Course Certificate