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      Suicidal and homicidal tendencies after Lyme disease: an ignored problem

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          Abstract

          Dear editor We would like to applaud the author for conducting such an important study by performing a comprehensive assessment of suicide and its association with Lyme-associated diseases (LADs).1 It is the first study of its kind, and it raises a need for further investigation on this subject. Suicide is a major health care issue in the USA, contributing to almost 42,773 deaths in the USA in 2014.2 There is no data available specific to suicide associated with LAD. Dr Bransfield inferred the possible prevalence of suicide associated with LAD by an indirect method which revealed that 414,540 patients with LAD have suicidal ideation, 31,100 attempt suicide and a total of 1,244 commit suicide in the USA per year from LAD.1,2 Several cases have been reported highlighting the issue of an association between suicide and LAD. A case report published in 2013 by Banerjee et al is an example where a case of 44-year-old male without any past psychiatric history presented with a third unsuccessful suicide attempt and was later diagnosed as having Borrelia infection. After 1 month of medical therapy with intravenous ceftriaxone, resulted in improvements in his mental status and resolution of suicidal ideation.3 Another set of cases was reported earlier in the 1990s by Fallon et al, highlighting suicidality in patients with Lyme disease. One of the two patients presented with neurological symptoms including fatigue, frontal headaches, and memory loss, and the second with a flu-like illness, joint pain, swollen glands, and fever. After further investigations, both of these patients were diagnosed with Lyme disease and appropriate treatment was offered. Few months after the treatment, both patients developed severe depression along with suicidal threats and an attempt by one patient. An evidence of persistent Lyme borreliosis was found in both cases.4 Another study reported in 2002 by Juchnowicz et al suggested that patients with Lyme borreliosis can experience psychiatric issues during both acute and late phases of the disease, most common being depression.5 In some cases, it slowly progresses to severity and suicidality as explained in the above cases, but in some cases, it is unpredictable. As evident from the above-reported cases, depression usually precedes suicidality. These reports point to a need of thorough case studies to find a link between such an important association, so that we can treat it accordingly. Although there is evidence proving the relationship of suicidality with LAD in this study, there is still a need for a more elaborative prospective cohort study highlighting different stages of the disease and percentage of people who develop suicidal thoughts during the disease course and to understand different patterns of development of such thoughts. No direct study has been conducted to estimate the prevalence of patients with LAD who committed suicide or had suicidal ideation. Also, more evidence is needed for a better understanding of the pathophysiology and biochemical mechanisms leading to depression and suicide in these patients. There is also need to explore the relationship of chronicity of Lyme borreliosis with other psychiatric diseases, such as bipolar disorder, leading to suicidal thoughts and attempts.

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          Suicide and Lyme and associated diseases

          Purpose The aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject. Introduction Multiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD. Method A retrospective chart review and epidemiological calculations were performed. Results LAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital–urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year. Conclusion Suicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.
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            Late-stage neuropsychiatric Lyme borreliosis. Differential diagnosis and treatment.

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              Lyme neuroborreliosis presenting with alexithymia and suicide attempts.

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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                2017
                02 August 2017
                : 13
                : 2069-2071
                Affiliations
                [1 ]Department of Psychiatry, Howard University, Washington, DC, USA
                [2 ]Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
                [3 ]Department of Psychiatry, University of North Dakota, Grand Forks, ND, USA
                Department of Psychiatry, Rutgers-RWJ Medical School, Piscataway, NJ, USA
                Author notes
                Correspondence: Muhammad Aadil, 415 Harlem Avenue, Chicago, 60130, IL, USA, Email muhammad.aadil9@ 123456gmail.com
                Correspondence: Robert C Bransfield, 225 Highway 35, Suite 107, Red Bank, NJ 07701, USA, Tel +1 732 741 3263, Fax +1 732 741 5308, Email bransfield@ 123456comcast.net
                Article
                ndt-13-2069
                10.2147/NDT.S145359
                5546819
                © 2017 Munir et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Letter

                Neurology

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