Two Cases Of Lyme Disease-Associated Obsessive Compulsive Disorder (OCD)
Posted Sep 12 2008 11:39am
Lyme Disease Foundation's XV International Conference on Lyme disease and other Tick-borne Disorders Farmington CT April 6-7, 2002
TWO CASES OF LYME DISEASE-ASSOCIATED OBSESSIVE COMPULSIVE DISORDER (OCD) ARE DESCRIBED. OBSESSIONS MAY BE TERMINATED SUDDENLY AND PERMANENTLY BY THE FIRST INJECTION OF IM PENICILLIN
Abstract by Virginia T. Sherr, M.D.
Known, but more often unsuspected, streptococcal infections have been revealed to be capable of creating obsessive compulsive symptoms that are in perfect agreement with the criteria of the Diagnostic and Statistical Manual, Edition IV--American Psychiatric Association. (1) In addition, these symptoms have cleared up following aggressive treatment by appropriate antibiotics. In relationship to another infection, chronic neuroborreliosis (chronic neuro-Lyme disease), the author finds there is much evidence that the spirochetal microbe, Borrelia burgdorferi, the cause of Lyme disease (LD), may likewise negatively affect parts of the brain that control OCD. In the case of the streptococcal and now spirochetal infections, it has been shown that antibiotics can be effective treatments of the psychiatric disorder. The disorder itself is one of the few wherein treatment improvements can be monitored and actually visualized by PET and more recently devised scans following therapy. Disordered dopamine and serotonin chemistry at the neuron level may create a kind of circular effect of thoughts or behavioral rituals. Some areas of the brain that are affected are the orbital frontal cortex, the caudate nuclei and the anterior cingulate regions. The following cases represent 2 patients who experienced the onset of severe obsessive and/or compulsive symptoms with onset of LD and how their treatment with antibiotics led to the defeat or the amelioration of those symptoms.
Patient 1--Obsessions. A circumspect 50 y-o woman developed constant, intrusive, sexual fantasies about a man whom she actively disliked. She felt helpless in the face of this unwanted, total preoccupation and was contemplating suicide when her LD was diagnosed and treated. Obsessions continued to torture her despite use of a variety of antibiotics and psychotropics until she received IM Bicillin 2.4 million units. Within 24 hours of the first dose her mind was cleared of the ideation. She was grateful that this burden had been lifted from her. The obsessions have not returned in the past 5 months. Now it takes great mental effort for her to think of the man at all.
Patient 2--Compulsive hand washing. A medical student had such a severe hand-washing ritual that he confined himself to his own room. He feared vague but horrific contaminations that might, through him, somehow harm his family. He described himself as having "magical thinking" that led to washing his hands raw. Debilitated, he thought that he was doomed. "When diagnosed and treated with antibiotics for LD, I felt much better and lost the magical thinking but the hand-washing continued." Luvox was added to his medications. This controlled the ritual washing enough to allow him to enroll in a different graduate program, living independently. In similar cases, usual OCD treatments such as high dose SSRI medications do not work well until treatment with antibiotics is undertaken.
1. Perlmutter SJ, Garvey MA, Castellanos X, et al. A case of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Am J Psychiatry 155:11, November 1998. (Re: PANDAS)