A Modest Proposal

In response to Dr. Virginia Sherr's letter in the July 3 issue about the increase in the number of patients showing an unusual syndrome of neurological soft signs that may be linked to Lyme and other tick-borne diseases, and in the interest of health, public safety, and quality of life, we, as psychiatrists, state the following:

Whereas:

1. Lyme disease and other tick-borne diseases are a serious public health threat;




2. These often cryptic diseases are associated with a broad spectrum of mental and other physical disorders, birth defects, and cognitive impairments that increase the risk of accidents, violence, memory loss, disabilities, and suffering;




3. Mental illnesses associated with these frequently unsuspected infections include, but are not limited to, depression, phobias, obsessive-compulsive disorders, panic disorders, aggressiveness, delusions, irritability, suicidality, exhaustion, sexual dysfunction, sleep disorders, eating disorders, and a broad spectrum of cognitive and neurological impairments. Findings more common in children include autism, Tourette syndrome, attention deficit disorder, dyslexia, lethargy, and a decline in grades, tantrums;




4. Since late-stage Lyme disease presents primarily as a neuropsychiatric rather than an arthritic disease, psychiatrists are encouraged to become more active in the diagnosis and treatment of Lyme disease;




5. The diagnosis of Lyme disease should take into consideration epidemiological risk factors for disease and be based upon a thorough history, physical findings (including neuropsychiatric), laboratory testing, and response to antibiotic therapy. Commonly used tests include the Western Blot, neuropsychological testing for the cognitive component, and SPECT scans. Tests that are being used with increasing acceptance include PCR, cultures, Lyme urine antigen test, and PET. Spinal taps are most commonly negative in the late-stage neuropsychiatric syndrome;




6. Research on early Lyme disease has been mistakenly utilized by some insurance companies as the standard that determines diagnostic and treatment guidelines for late-stage Lyme disease. This position results in the inappropriate denial of reimbursement for vital ongoing medical care;




7. We recognize the need for long-term antibiotic treatment in some of these patients. We are concerned that financially motivated, restrictive treatment guidelines of some of the insurance companies are harmful to patients and the overall public welfare;




8. Public awareness, education, prevention, vaccines, early diagnosis, correct psychiatric diagnosis, effective treatment, guidance throughout the treatment, advocacy, and research help to reduce the seriousness of this epidemic;




9. We acknowledge and support the efforts of patients, support groups, clinicians, researchers, drug companies, and advocates who show the commitment, courage, and creativity to meet the challenge of tick-borne diseases;




10. In addition to tick-borne diseases, other infectious diseases and complex interactive infectious diseases are increasingly recognized as being associated with mental illness.

We therefore advise that:

1. An APA committee be established to better coordinate information, research, education, policy, and guidelines in this area;




2. The name of the committee shall be the Committee on Tick-Borne and Other Complex Infectious Encephalopathies.

Robert C. Bransfield, M.D
Red Bank, N.J.

Brian Fallon, M.D., M.P.H.
New York, N.Y.

Bernard Raxlen M.D.
Greenwich Conn.

Lynn Shepler, M.D., J.D.
Falmouth, Mass.

Virginia Sherr, M.D.
Holland, Pa.