Painful hallucinations and somatic delusions in a patient with the possible diagnosis of neuroborreliosis.
Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.
Bär
Karl-Jürgen
KJ
Department of Psychiatry, Friedrich-Schiller-University of Jena, Jena, Germany. karl-juergen.baer@med.uni-jena.de
Jochum
Thomas
T
Häger
Frank
F
Meissner
Winfried
W
Sauer
Heinrich
H
D014150:Antipsychotic Agents / Q000627:therapeutic use; D001899:Borrelia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D003702:Delusions / Q000175:diagnosis* / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D010147:Pain Measurement; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology; D012565:Schizophrenic Psychology; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome
D014150:Antipsychotic Agents