Aggression and Lyme Disease

[Guest guest]

Aggression and Lyme Disease

by Robert C. Bransfield, M.D.

_http://www.mentalhealthandillness.com/lymeframes.html_

(http://www.mentalhealthandillness.com/lymeframes.html)

 

Several years ago, I admitted a patient with Lyme disease (LD) to a

psychiatric unit. He was para & shy;noid and assaulted five police officers in an

episode of rage. During the hospital stay, the patient went to the river

behind the hospital to watch the Fourth of July fireworks display. When the

fireworks began, the patient jumped into the river. It appeared the loud noise

was responsible for an acoustic startle reaction.

At the same time, a female patient with LD was also on the unit. She

described puzzling symp & shy;toms that consisted of episodes of rage and

intrusive, horrific homicidal images. In both cases, the aggres & shy;sive

tendencies

improved with treatment.

In reviewing cases involving LD patients, another patient described an

incident where some & shy;one else pulled into a parking space that he wanted.

Jumping out of his car, he knocked the other driver unconscious. Still

another patient stated he was driv & shy;ing on the highway when a motorist

beeped

their horn. He lunged out of his car and began pounding on the windshield

of the car, then suddenly stopped in bewilderment because he did not

understand or recall why he was behaving in this manner.

A female patient was arrested for shoplifting during a state of confusion.

Another patient was accused of pedophilia. I can cite many more examples.

When we look at cases of aggression associated with LD, were all of these

cases merely a coincidence or a causal relationship between LD and some of

this aggressive behavior?

Adler methodically interviewing hundreds of patients over a period of

years, it was clear that cer & shy;tain patterns were emerging. The same problems

were being seen in too many patients. A causal link was becoming

increasing apparent. I would like to em & shy;phasize that the vast majority of

patients who know they have LD are not violent. It is not my intention to draw

attention to an issue that further increases the stigma that LD patients

already receive. However, it is my intention to methodically look at the

association that does seem to exist between LD and aggressive behavior in a

minority of chronic LD patients.

Clearly violence is a very complex issue. Many different factors have

contributory or deterrent effects. One study of death row inmates demonstrated

that 100% were neurologically impaired. Many also had a history of abuse.

Sometimes the abuse precedes or causes the neurological impairment.

Sometimes the neurological impairment precedes or causes the abuse. Neurological

impairments and abuse either alone or in combination are significant risk

factors that increase the potential for violence. Other risk factors are

significant in some cases.

A triggering event(s) may then occur which provokes violent behavior in a

person who is at risk. A normal person given the same level of provocation

does not act in a violent manner. In some cases, the trigger is an

intrusive, violent image, an obsession or compulsion to do harm, or it may be a

perception of threat.

In addition to a provocative factor, there are many deterrents to

violence, which include a neuro & shy;logical capacity for restraint, social

bonding,

victim response, and social structures. When violence occurs, we need to

consider some combination of increased risk factors, triggering events, or a

failure of deterrents to violence.

It is well recognized that LD causes dysfunc & shy;tion of the central

nervous system (CNS). Many other conditions which cause CNS dysfunction are

some & shy;times also associated with violent behavior, i.e.: strokes, brain

tumors, lupus, MS. head injuries, developmen & shy;tal disabilities, carbon

monoxide poisoning, syphilis and other CNS infections. When reviewing the

pathology associated with aggression, we can see dysfunction of a number of

different brain areas.

To briefly review the physiology, there is a hi & shy;erarchy of functioning

within the CNS, which has de & shy;veloped through evolution. When we go

from the most advanced to the most primitive areas of the brain, the hierarchy

consists of the prefrontal cortex, other cor & shy;tical regions, para

limbic asso & shy;ciative areas, the limbic system, and the brain stem and

hypo & shy;thalamus. These centers func & shy;tion together with many feed forward

and

feed back path & shy;ways that are both stimulatory and inhibitory. Injury

to a higher center can result in a dysfunction or a loss of a function.

Injury to an inhibit & shy;ing pathway will cause a decline or an inability to

in & shy;hibit that function. As a result, brain injury leads to a decline in

our ability to fine-tune our adaptive abilities in an effective manner.

In the case of aggressive functioning, injury can lead to apathy (a

failure of stimulation) and/or aggres & shy;sion (a failure a inhibition,

modulation, or association) Since circuits controlling aggression are often

parallel

with sex and feeding, we often see aggressive disor & shy;ders in

combination with sexual dysfunction and eat & shy;ing disorders. Different

patterns of

brain injury result in different patterns of symptoms.

Now let’s look at the association between Lyme and aggression. The first

reference on this sub & shy;ject in the medical literature I could find was

made by Fallon, et al in 1992 in ‘The Neuropsychiatric Mani & shy;festations of

Lyme Borreliosisâ€, in which he described a man acutely sensitive to sound

was so intensely both & shy;ered by the noise his three-year-old son was

making that he picked him up and shook him in a sudden and unprecedented fit of

violence. Other cases can be found in medical literature cited at Lyme

meetings and in newspaper reports. The phrase “Lyme rage†continues to

appear

on the Internet. There are discussions that some “road rage†is caused by

“Lyme rageâ€.

I would estimate aggressive behavior has been a significant issue for

approximately fifty patients with LD that I have evaluated or treated, although

many more have reported some symptoms associated with aggressive

potential. When aggression does occur, it may only be present for an interval

in the

progression of the illness.

Deficits caused by LD that are sometimes as & shy;sociated with increased

risk for aggressive behavior may include:

1. Decreased frustration tolerance. (This is magnified by the

increased frustration caused by a chronic illness).

2. Decreased impulse control.

3. When mild, the combination of decreased frustra & shy;tion tolerance

and decreased impulse control leads to irritability. When more extreme,

this combination can result in explosive anger.

4. Hyposexuality and hypersexuality caused by LD, both of which cause

increased interpersonal frus & shy;tration.

5. Dysfunction causing different forms of obsessive compulsive

disorder, which results in intrusive thoughts, images, and compulsions that

sometimes are of an aggressive nature.

6. Some dysfunction results in a decreased bonding capacity.

7. Increased startle reflex - particu & shy;larly increased acoustic

startle.

8. Hypervigilance and paranoia

9. Delusions and hallucinations.

10. Some patients acquire impairment in their ability to regulate the

arousal level of an emotion. As a result, emotions such as anger may be all or

none, excessively intense, and not proportionate to the current

situa & shy;tion. This also leads to a decline in the ability to integrate

concurrent

emotions that exist either within the patient or in a relationship with

another person. This symptom may in turn intensify other psychiat & shy;ric

syndromes such as post-traumatic stress disor & shy;der, dissociative disorders,

borderline personality, and narcissistic personality disorders.

Any combination of the above impairments can result in aggressive

behavior. When these changes occur in a mature adult, the patient is surprised

by

the symptoms - they recognize it is pathological and attempt to compensate

for the deficits. However, children who never had the reference point of a

mature level of functioning are at a greater risk. Some of the most

threatening cases were patients who were infected at a young age.

The following is a quote from a patient describing horrific intrusive

images, which many patients with Lyme have described to me:

“Frightening, stabbing, horrific images -usually of death, dying or pain

and suffering. Often gory and unreal as in a horror story. Faces mostly with

blood or terror exaggerated awful expressions. Visions of stabbing or

killing often of those close to you or familiar. These penetrating images add

to

the already anxious condition of a Lymey. Episodic, not continuous.

Fleeting faces most usually of the worse possible situation Helpless stumped

bodies perhaps close to death. These images don’t seem to neces & shy;sarily be

associated with a particular occasion, place or time, but come and invade

the privacy of my mind. Control over physical well-being is lost with Lyme,

but much more disturbing and debilitating is the lack of control or normalcy

of the mind both emotionally and cognitive - perhaps worse during a flair

when all symptoms often rear their ugly heads. It is a crushing experience

to survive these images feeling possessed or evil. If they were to be

continuous and not fleeting, no-one could or would survive.â€

In another case, a patient had no prior history of mental illness suicidal

or homicidal tendencies. -The patient went to their HMO --primary care

physician complaining of an apparent tick bite. It is reported that the doctor

neither sent the patient for testing nor initially offered antibiotic

treatment. As symptoms progressed, the patient was diagnosed with fibromyalgia.

Subsequent symptoms included word substitutions, getting lost, losing

items, and an inability to find their car in a parking lot. Eventual tests

confirming LD included a Western Blot, brain SPECT, and an ophthalmologic exam.

The patient improved with treatment of several weeks on IV antibiotics and

was stopped as per the managed care guidelines. The patient relapsed and

further treatment was denied. Their mental state declined and subsequently

there was a combined homicide-suicide.

In conclusion, based on my observations and clinical judgment, chronic

relapsing LD at times causes aggressive behavior, which can manifest in a

number of different forms. Since this is aggression associated with a CNS

infection, it can potentially be treated and prevented. If only a small percent

of chronic LD patients are affected, the total number of cases is still

quite significant. Since this is a late stage manifestation, the increasing

number of individuals infected with Bb raises serious concern that violence

associated with or caused by LD will increase in the future.

What can we do now to prevent a possible future epidemic of violence?

Suggestions include high index suspicion for Lyme disease in rageful people,

adequate testing for Lyme disease in those who are enraged, adequate treatment

of LD, contin & shy;ued LD advocacy efforts, research into the link between

aggression and LD, evaluation of violent offenders who demonstrate some of

the aggressive patterns seen with LD prior to their release into the

community, and vaccinations. When regional epidemics of violence occur, LD and

other causes of encephalopathy should be considered. We should exercise every

option to prevent crime with medical treatment.

If anyone has information relevant to this issue, I invite him or her to

write subsequent ar & shy;ticles.

Articles Published in the Lyme Alliance Newsletter

By Robert C Bransfield, MD

_http://www.mentalhealthandillness.com/lymeArticles.htm_

(http://www.mentalhealthandillness.com/lymeArticles.htm)

 

 

 

[Guest guest]

your points are very well noted and not to take away from it,

but to give you something to think about -

violence is tied to anger and anger is tied to the liver.

when you have lyme your detoxification pathways are clogged

and stuff gets hung up in there (liver)..

in all the violence and rage and other organs mentioned i didn't

see you mention the liver.

carol

 

 

, bestsurprise2002 wrote:

>

>

> Aggression and Lyme Disease

> by Robert C. Bransfield, M.D.

> _http://www.mentalhealthandillness.com/lymeframes.html_

> (http://www.mentalhealthandillness.com/lymeframes.html)

>

> Several years ago, I admitted a patient with Lyme disease (LD) to a

> psychiatric unit. He was para & shy;noid and assaulted five police officers in

an

> episode of rage. During the hospital stay, the patient went to the river

> behind the hospital to watch the Fourth of July fireworks display. When the

> fireworks began, the patient jumped into the river. It appeared the loud

noise

> was responsible for an acoustic startle reaction.

> At the same time, a female patient with LD was also on the unit. She

> described puzzling symp & shy;toms that consisted of episodes of rage and

> intrusive, horrific homicidal images. In both cases, the aggres & shy;sive

tendencies

> improved with treatment.

> In reviewing cases involving LD patients, another patient described an

> incident where some & shy;one else pulled into a parking space that he wanted.

> Jumping out of his car, he knocked the other driver unconscious. Still

> another patient stated he was driv & shy;ing on the highway when a motorist

beeped

> their horn. He lunged out of his car and began pounding on the windshield

> of the car, then suddenly stopped in bewilderment because he did not

> understand or recall why he was behaving in this manner.

> A female patient was arrested for shoplifting during a state of confusion.

> Another patient was accused of pedophilia. I can cite many more examples.

> When we look at cases of aggression associated with LD, were all of these

> cases merely a coincidence or a causal relationship between LD and some of

> this aggressive behavior?

> Adler methodically interviewing hundreds of patients over a period of

> years, it was clear that cer & shy;tain patterns were emerging. The same

problems

> were being seen in too many patients. A causal link was becoming

> increasing apparent. I would like to em & shy;phasize that the vast majority of

> patients who know they have LD are not violent. It is not my intention to

draw

> attention to an issue that further increases the stigma that LD patients

> already receive. However, it is my intention to methodically look at the

> association that does seem to exist between LD and aggressive behavior in a

> minority of chronic LD patients.

> Clearly violence is a very complex issue. Many different factors have

> contributory or deterrent effects. One study of death row inmates

demonstrated

> that 100% were neurologically impaired. Many also had a history of abuse.

> Sometimes the abuse precedes or causes the neurological impairment.

> Sometimes the neurological impairment precedes or causes the abuse.

Neurological

> impairments and abuse either alone or in combination are significant risk

> factors that increase the potential for violence. Other risk factors are

> significant in some cases.

> A triggering event(s) may then occur which provokes violent behavior in a

> person who is at risk. A normal person given the same level of provocation

> does not act in a violent manner. In some cases, the trigger is an

> intrusive, violent image, an obsession or compulsion to do harm, or it may be

a

> perception of threat.

> In addition to a provocative factor, there are many deterrents to

> violence, which include a neuro & shy;logical capacity for restraint, social

bonding,

> victim response, and social structures. When violence occurs, we need to

> consider some combination of increased risk factors, triggering events, or a

> failure of deterrents to violence.

> It is well recognized that LD causes dysfunc & shy;tion of the central

> nervous system (CNS). Many other conditions which cause CNS dysfunction are

> some & shy;times also associated with violent behavior, i.e.: strokes, brain

> tumors, lupus, MS. head injuries, developmen & shy;tal disabilities, carbon

> monoxide poisoning, syphilis and other CNS infections. When reviewing the

> pathology associated with aggression, we can see dysfunction of a number of

> different brain areas.

> To briefly review the physiology, there is a hi & shy;erarchy of functioning

> within the CNS, which has de & shy;veloped through evolution. When we go

> from the most advanced to the most primitive areas of the brain, the

hierarchy

> consists of the prefrontal cortex, other cor & shy;tical regions, para

> limbic asso & shy;ciative areas, the limbic system, and the brain stem and

> hypo & shy;thalamus. These centers func & shy;tion together with many feed

forward and

> feed back path & shy;ways that are both stimulatory and inhibitory. Injury

> to a higher center can result in a dysfunction or a loss of a function.

> Injury to an inhibit & shy;ing pathway will cause a decline or an inability to

> in & shy;hibit that function. As a result, brain injury leads to a decline in

> our ability to fine-tune our adaptive abilities in an effective manner.

> In the case of aggressive functioning, injury can lead to apathy (a

> failure of stimulation) and/or aggres & shy;sion (a failure a inhibition,

> modulation, or association) Since circuits controlling aggression are often

parallel

> with sex and feeding, we often see aggressive disor & shy;ders in

> combination with sexual dysfunction and eat & shy;ing disorders. Different

patterns of

> brain injury result in different patterns of symptoms.

> Now let’s look at the association between Lyme and aggression. The first

> reference on this sub & shy;ject in the medical literature I could find was

> made by Fallon, et al in 1992 in ‘The Neuropsychiatric Mani & shy;festations

of

> Lyme Borreliosisâ€, in which he described a man acutely sensitive to sound

> was so intensely both & shy;ered by the noise his three-year-old son was

> making that he picked him up and shook him in a sudden and unprecedented fit

of

> violence. Other cases can be found in medical literature cited at Lyme

> meetings and in newspaper reports. The phrase “Lyme rage†continues to

appear

> on the Internet. There are discussions that some “road rage†is caused by

> “Lyme rageâ€.

> I would estimate aggressive behavior has been a significant issue for

> approximately fifty patients with LD that I have evaluated or treated,

although

> many more have reported some symptoms associated with aggressive

> potential. When aggression does occur, it may only be present for an interval

in the

> progression of the illness.

> Deficits caused by LD that are sometimes as & shy;sociated with increased

> risk for aggressive behavior may include:

> 1. Decreased frustration tolerance. (This is magnified by the

> increased frustration caused by a chronic illness).

> 2. Decreased impulse control.

> 3. When mild, the combination of decreased frustra & shy;tion tolerance

> and decreased impulse control leads to irritability. When more extreme,

> this combination can result in explosive anger.

> 4. Hyposexuality and hypersexuality caused by LD, both of which cause

> increased interpersonal frus & shy;tration.

> 5. Dysfunction causing different forms of obsessive compulsive

> disorder, which results in intrusive thoughts, images, and compulsions that

> sometimes are of an aggressive nature.

> 6. Some dysfunction results in a decreased bonding capacity.

> 7. Increased startle reflex - particu & shy;larly increased acoustic

> startle.

> 8. Hypervigilance and paranoia

> 9. Delusions and hallucinations.

> 10. Some patients acquire impairment in their ability to regulate the

> arousal level of an emotion. As a result, emotions such as anger may be all or

> none, excessively intense, and not proportionate to the current

> situa & shy;tion. This also leads to a decline in the ability to integrate

concurrent

> emotions that exist either within the patient or in a relationship with

> another person. This symptom may in turn intensify other psychiat & shy;ric

> syndromes such as post-traumatic stress disor & shy;der, dissociative

disorders,

> borderline personality, and narcissistic personality disorders.

> Any combination of the above impairments can result in aggressive

> behavior. When these changes occur in a mature adult, the patient is

surprised by

> the symptoms - they recognize it is pathological and attempt to compensate

> for the deficits. However, children who never had the reference point of a

> mature level of functioning are at a greater risk. Some of the most

> threatening cases were patients who were infected at a young age.

> The following is a quote from a patient describing horrific intrusive

> images, which many patients with Lyme have described to me:

> “Frightening, stabbing, horrific images -usually of death, dying or pain

> and suffering. Often gory and unreal as in a horror story. Faces mostly with

> blood or terror exaggerated awful expressions. Visions of stabbing or

> killing often of those close to you or familiar. These penetrating images add

to

> the already anxious condition of a Lymey. Episodic, not continuous.

> Fleeting faces most usually of the worse possible situation Helpless stumped

> bodies perhaps close to death. These images don’t seem to neces & shy;sarily

be

> associated with a particular occasion, place or time, but come and invade

> the privacy of my mind. Control over physical well-being is lost with Lyme,

> but much more disturbing and debilitating is the lack of control or normalcy

> of the mind both emotionally and cognitive - perhaps worse during a flair

> when all symptoms often rear their ugly heads. It is a crushing experience

> to survive these images feeling possessed or evil. If they were to be

> continuous and not fleeting, no-one could or would survive.â€

> In another case, a patient had no prior history of mental illness suicidal

> or homicidal tendencies. -The patient went to their HMO --primary care

> physician complaining of an apparent tick bite. It is reported that the

doctor

> neither sent the patient for testing nor initially offered antibiotic

> treatment. As symptoms progressed, the patient was diagnosed with

fibromyalgia.

> Subsequent symptoms included word substitutions, getting lost, losing

> items, and an inability to find their car in a parking lot. Eventual tests

> confirming LD included a Western Blot, brain SPECT, and an ophthalmologic

exam.

> The patient improved with treatment of several weeks on IV antibiotics and

> was stopped as per the managed care guidelines. The patient relapsed and

> further treatment was denied. Their mental state declined and subsequently

> there was a combined homicide-suicide.

> In conclusion, based on my observations and clinical judgment, chronic

> relapsing LD at times causes aggressive behavior, which can manifest in a

> number of different forms. Since this is aggression associated with a CNS

> infection, it can potentially be treated and prevented. If only a small

percent

> of chronic LD patients are affected, the total number of cases is still

> quite significant. Since this is a late stage manifestation, the increasing

> number of individuals infected with Bb raises serious concern that violence

> associated with or caused by LD will increase in the future.

> What can we do now to prevent a possible future epidemic of violence?

> Suggestions include high index suspicion for Lyme disease in rageful people,

> adequate testing for Lyme disease in those who are enraged, adequate treatment

> of LD, contin & shy;ued LD advocacy efforts, research into the link between

> aggression and LD, evaluation of violent offenders who demonstrate some of

> the aggressive patterns seen with LD prior to their release into the

> community, and vaccinations. When regional epidemics of violence occur, LD

and

> other causes of encephalopathy should be considered. We should exercise every

> option to prevent crime with medical treatment.

> If anyone has information relevant to this issue, I invite him or her to

> write subsequent ar & shy;ticles.

> Articles Published in the Lyme Alliance Newsletter

> By Robert C Bransfield, MD

> _http://www.mentalhealthandillness.com/lymeArticles.htm_

> (http://www.mentalhealthandillness.com/lymeArticles.htm)

>

>

>