Mental Health Archives

New Massachusetts General Hospital study on important heart issues in Lyme disease patients

Elizabeth Lee-Lewandrowski, PhD, MPH on August 9, 2023

A Massachusetts General Hospital study that raises the awareness of possible cardiac involvement in early Lyme patients was recently published. This small study is the first to use data that measures a complex protein (troponin) to detect possible cardiac involvement in patients with early Lyme disease and with subclinical, or non-noticeable cardiac symptoms. Overall, 14.6% of the study subjects had elevated troponin T levels above the normal range. These findings were published in the March 2022 issue of Annals of Clinical & Laboratory Science and are explained in a new course from Invisible International, taught by first author Elizabeth Lee Lewandrowski, PhD, MPH, an Assistant Professor of Pathology at Harvard Medical School, a Faculty Researcher and Clinical Laboratory Scientist in Pathology at Massachusetts General Hospital, and Invisible International’s Research Director.

Troponin is a complex of three proteins (troponin T, I, and C) that regulate muscle contractions in the heart. When the heart is damaged, these proteins are released into the bloodstream, allowing clinicians to measure levels to determine the extent of heart damage. Both troponin T and I are detected and elevated in the blood when the heart is negatively impacted by various conditions, including infection, inflammation, or muscle damage. Therefore, this is potentially an important test for doctors to follow in the event of suspected cardiac involvement including subclinical cardiac involvement in patients with Lyme disease.

Previously, the Centers for Disease Control and Prevention reported that Lyme carditis occurs only in about 1% of Lyme disease cases (2008 to 2017). This newer study of 41 early Lyme patients used the high sensitivity troponin T test and found that 14.6% had elevated troponin T levels, suggesting that the heart is damaged in more early Lyme disease cases than previously realized. This finding should be brought to the attention of healthcare providers as it suggests cardiac involvement in early Lyme disease may be more common than previously realized. While there are many explanations for elevated troponin levels in these patients, including a systemic inflammatory response, this result raises the question that subclinical cardiac involvement may be more common than previously recognized. Further investigation is necessary to explore and validate the significance of this finding.

Some of the heart conditions that troponin T tests can detect include electrical disruptions (AV block, most common in Lyme carditis), inflammation (myocarditis), swelling of the heart sac (pericarditis), inflammation of the inner lining and valves (endocarditis), problems with the pumping action (cardiomyopathy), and heart attacks (myocardial infarctions). Some of these conditions can be fatal, emphasizing the need for rapid diagnosis and treatment when Lyme carditis is suspected.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/measurement-of-high-sensitivity-troponin-t-in-patients-with-early-stage-lyme-disease-possible-evidence-for-subclinical-cardiac-involvement/

New course on One Health strategies for diagnosing Lyme disease

Kris Newby on July 20, 2023

If you’re a clinician looking for new evidence-based insights into diagnosing Lyme disease, this course is a good starting place. It begins with a brief overview of the One Health approach to combating vector-borne diseases. Then it applies this framework to Lyme disease, which accounted for 60% of all vector-borne diseases in the U.S. from 2004 to 2016.

Early Lyme diagnostic strategies are addressed by Elizabeth Maloney, MD, the Education Co-director at Invisible, a Minnesota family physician, and the founder/president of Partnership for Tick-borne Diseases Education, a nonprofit providing evidence-based education on tick-borne diseases. Dr. Malone reviews four cases that highlight symptom patterns to look for in diagnosing early Lyme, Lyme carditis, and cranial neuritis, which often presents as facial Bell’s Palsy. She also discusses the flaws inherent in current Lyme diagnostic tests.

Late-stage Lyme disease rehabilitation is covered by Nevena Zubcevik, DO, Chief Medical Officer of Invisible International, previously co-founder and co-director of the Dean Center for Tick Borne Illness at the Spaulding Rehabilitation Hospital, an affiliate of Harvard Medical School. Dr. Zubcevik emphasizes that Lyme diagnostics aren’t always reliable for late-stage Lyme, so she presents evidence-based symptom clusters that may help clinicians with diagnoses. To assess the nervous system inflammation that is characteristic of late Lyme, she recommends taking a punch biopsy to test for small fiber neuropathy, and PET brain scans to confirm the inflammation that is at the root of the memory deficits found in 74% of these patients.

In addition to this course, Invisible offers resources to help in clinicians in the diagnostic process. These include a General Symptom Questionnaire (GSQ-30) for assessing patient impairment; a health risk assessment tool that helps patients think about exposures to environmental, animal, and travel-related diseases that might be contributing to ill health; and an evidence-based symptom list for babesiosis, bartonellosis and (Lyme) borreliosis, all common tick-borne diseases.

Invisible International is developing courses and clinician tools like these to accelerate the movement of new research to frontline clinicians. We hope these anytime, anywhere courses will grow the pool of health-care providers who are experienced in the diagnosis and treatment of tick- and other vector-borne diseases. This means fewer patients will have to travel long distances and wait months for an initial appointment. Education heals.

How education can bend the curve in the tick-borne disease epidemic

Kris Newby on May 11, 2023

There’s a dire shortage of health-care providers who are experienced in the diagnosis and treatment of tick- and other vector-borne diseases. This means many suffering patients must travel long distances and wait months for an initial appointment, leading to worse patient outcomes. [1]

There are immense insurance and logistical barriers that discourage providers from taking on patients with tick-borne diseases. Some of these were identified in a 2022 survey-study of 155 clinicians from 30 states who treat Lyme patients. They included complexity of care (79%), the cognitive impairment of patients (57%), and frequent patient calls between scheduled appointments (49%). [1]

This shortage of trained providers is getting worse as the incidence of vector-borne diseases rises. The Centers for Disease Control reports that:

Diseases spread by mosquitoes, ticks, & fleas tripled in the U.S., 2004-2016.
Since 2004, 9 new pathogens spread by mosquitoes & ticks have been discovered.
476,000 Americans are diagnosed with Lyme disease each year, in all 50 states.

Despite the alarming rise in these diseases, a 2023 study led by Cornell University, “Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers,” found a “limited availability of continuing education for multiple life-threatening tick-borne diseases of increasing importance in the United States.” [2]

Invisible International is filling this educational gap by producing best-in-class Continuing Medical Education (CME) courses on vector-borne and environmental disease, available to anyone online for no cost. These courses cover prevention, diagnosis, and treatment of these disease.

What is CME?

Continuing Medical Education (CME) educational activities are classes, workshops, or conferences that increase the knowledge and skills of health-care providers, ensuring that they stay current on the latest medical research and best medical practices. Some states require that doctors, nurses, and other health professionals accrue a certain number of CME course credits each year to keep their medical licenses active.

What is unique about its CME offerings?

Invisible has one of the largest online CME collections of vector-borne diseases available. The courses are delivered by some of the most knowledgeable experts in their respective fields, featuring topics like persistent Lyme disease, the Bartonelloses, Lyme disease treatment, and neuropsychiatric symptoms of tick-borne diseases. Our courses incorporate the One Health concept, a recognition that the health of humans, pets, and the environment are all intertwined.

What is CME accreditation?

CME courses can be developed by medical societies, universities, companies, or nonprofits such as Invisible International. For these activities to be counted towards annual CME totals, they must be approved by independent accreditation organizations. This ensures that the educational activities are relevant, practice-based, effective, based on valid content, and independent of commercial influence.

Is Invisible’s CME accredited?

Invisible International’s Continuing Medical Education (CME) platform is accredited by two governing bodies:

The Accreditation Council for Continuing Medical Education (ACCME) sets course development guidelines to ensure accurate, balanced, scientifically justified clinical-practice recommendations, all free of commercial bias.
The American Academy of Family Physicians (AAFP) reviews individual courses to ensure that they:
- are relevant to family practice
- are evidence-based
- communicate the risks and benefits of clinical recommendations
- evaluate a learner’s grasp of the material.

Physicians taking AAFP-approved courses can receive reciprocal continuing education credits from the American Medical Association, (AMA), the American Osteopathic Association (AOA), the College of Family Physicians of Canada (CFPC), and other health professional organizations.

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[1] Johnson LB, Maloney EL. Access to Care in Lyme Disease: Clinician Barriers to Providing Care. Healthcare. 2022; 10(10):1882. https://doi.org/10.3390/healthcare10101882

The authors of this study are Elizabeth L. Maloney, MD, a Minnesota family physician and Invisible’s education co-director; and Lorraine Johnson, JD, MBA, the Chief Executive Officer of LymeDisease.org and the principal investigator of its patient registry and research platform, MyLymeData.

[2] Malkowski AC, Smith RP, MacQueen D, Mader EM. Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers. PRiMER. 2023;7:497812. Published 2023 Feb 2. doi:10.22454/PRiMER.2023.497812

Neuropsychiatric Lyme symptoms: A new masterclass

Kris Newby on March 11, 2023

Invisible International has just released an important medical education course on neuropsychiatric symptoms associated with Lyme disease, with treatment recommendations for specific manifestations. The course is taught by Shannon Delaney, MD, MA, an assistant professor in the Department of Psychiatry and neuropsychiatrist at Columbia University Irving Medical Center.

A key section of the course reviews the latest evidence on Lyme disease persistence after standard treatments, useful in overturning the long-held belief that Lyme disease is always easy to treat and cure.

“It’s staggering,” said Dr. Delaney. “Months to years after the initial infection of Borrelia burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis,” she said.

Other topics covered in this masterclass include:

The definition of Post-Treatment Lyme Disease Syndrome (PTLDS), as defined by the medical community.
Case studies that illustrate the unreliability of testing for neurological Lyme disease.
Immune system biomarkers associated with neurological Lyme disease.
A description of how the Lyme bacteria creates disease in humans.

Dr. Delaney also reviews a cohort study that analyzed the clinical data of 12,616 Lyme disease patients over 22 years. The study, a collaboration of Columbia University and the Copenhagen Research Centre for Mental Health, is believed to be the first large, population-based study examining the relationship between Lyme disease and psychiatric outcomes. The results are a wakeup call for those who think of Lyme as a disease of mainly rashes and swollen joints; the study found that patients who received a hospital diagnosis of Lyme disease—inpatient, outpatient, or at the ER—had a 28 percent higher rate of mental disorders and were twice as likely to have attempted suicide post-infection, compared to individuals without the diagnosis.

This course reinforces the need for physicians to consider mental health symptoms when developing treatment plans for tick-borne disease patients.

Watch here: https://learn.invisible.international/courses/neuropsychiatric-symptoms-with-lyme-disease-tick-borne-illness/

Lyme disease heightens risk of mental disorders, suicidality

Carla Cantor, Columbia University on August 17, 2021

A Columbia-led study advises physicians and patients to be aware of psychiatric symptoms, particularly the first year after diagnosis

In a new study, U.S. and Danish researchers report that patients who received a hospital diagnosis of Lyme disease—inpatient, outpatient, or at the ER—had a 28 percent higher rate of mental disorders and were twice as likely to have attempted suicide post-infection, compared to individuals without the diagnosis.

The study, a collaboration of Columbia University and the Copenhagen Research Centre for Mental Health, is believed to be the first large, population-based study examining the relationship between Lyme disease and psychiatric outcomes.

The research appears in the July 28 online edition of the American Journal of Psychiatry (link is external and opens in a new window)

“It is time to move beyond thinking of Lyme disease as a simple illness that only causes a rash,” said Brian Fallon, MD, MPH, a psychiatrist with the New York State Psychiatric Institute and Columbia University who is the lead author of the paper. “In addition to the risk of severe cardiac, rheumatologic, and neurologic problems, Lyme disease can cause severe mental health problems as well.”

Dr. Fallon, one of the foremost researchers of the neuropsychiatric effects of Lyme disease, is director of the Lyme and Tick-borne Diseases Research Center at Columbia. The team of investigators on the study includes Michael Benros MD, PhD, principal investigator; Trine Madsen, PhD, co-first author; and Annette Erlangsen, PhD, all psychiatric epidemiologists at the Research Centre for Mental Health.

Higher Rate of Death by Suicide

To conduct their study, the researchers analyzed the medical record diagnoses of nearly 7 million people living in Denmark over a 22-year period, comparing the mental health data of individuals after a hospital-based diagnosis of Lyme disease to the rest of the Danish population who had never had a Lyme diagnosis recorded in the national medical register.

Patients who had a history of mental disorder or suicidality prior to the Lyme disease diagnosis were excluded from the analysis.

The analysis revealed that in addition to patients with Lyme disease being at greater risk of mental disorders and suicide attempts, they also had a 42 percent higher rate of affective disorders, such as depression and bipolar disorder, and a 75 percent higher rate of death by suicide than those without the diagnosis.

Additionally, having more than one episode of Lyme disease was associated with a higher rate of mental disorders, affective disorders, and suicide attempts.

Half a Million People Treated for Lyme Disease Each Year

Each year nearly half a million people in the United States are diagnosed and treated for Lyme disease, also known as Lyme borreliosis, caused by a bacterium carried by deer ticks and transmitted to humans through their bite. The majority of cases have been reported in the northeastern, mid-Atlantic, and north-central states, but the geographic range where ticks and tick-borne diseases are found continues to expand.

Although most cases can be cured with a two- to four-week course of oral antibiotics, 10-20 percent of patients may suffer with symptoms of pain, fatigue, or difficulty thinking that last for months to years after treatment.

Several studies have pointed to a connection between Lyme disease and cognitive disorders months to years after antibiotic therapy or in people with untreated infections. In severe cases, individuals with late-stage Lyme disease may experience impaired concentration, irritability, memory and sleep disorders, and painful nerve dysfunction.

Dr. Michael Benros emphasizes that most people do not develop severe mental health issues after Lyme borreliosis. During the study period, only 7 percent of the nearly 13,000 individuals with a hospital diagnosis of Lyme disease followed up with hospital clinicians complaining of symptoms subsequently diagnosed as mental disorders.

Clinicians and Patients Should Be Aware of Risk

But findings of the study, the researchers said, are emblematic of a trend in Lyme disease cases that should not be overlooked. The Danish medical registry includes only psychiatric diagnosis made in a hospital setting – not by clinicians in communities – and it is likely that the number of individuals with new onset mental health problems following infection is much higher.

“This nationwide study confirms the association between Lyme disease and psychiatric disorders,” Dr. Benros said. “Treating clinicians and patients should be aware of an increased risk of mental health problems, particularly during the first year after a severe Lyme disease infection, and if mental health issues arise, patients should seek treatment and guidance. “

The study, “Lyme Borreliosis and Associations with Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study,” was funded by the Global Lyme Alliance, Inc.

A message from Invisible’s Chief Medical Officer

Nev Zubcevik on August 17, 2021

The groundbreaking study on Lyme and mental health from Columbia University shines a light on an utterly shocking statistic: People suffering from Lyme borreliosis have “a two-fold higher risk of dying by suicide than those without Lyme disease.”

As a clinician who has been treating Lyme patients for years, I see many reasons for this preventable loss of life. The biggest factor, in my opinion, is that these sufferers feel abandoned and stigmatized by the medical system and society at large. Lyme disease has no reliable test, no vaccine, and no effective treatments in the chronic stages of the disease. Yet physicians and family members often tell them that their very real disease is “all in their heads.” They feel invisible.

To respond to this urgent need, Invisible International is planning two important projects. The first is the Tick Bytes Clinical Data Research Platform, a nationwide clinical data repository that will provide quality tick-borne illness patient data to researchers to facilitate the development of better symptomologies, diagnostic approaches, and treatment protocols. We are currently working to fund 10 data-collection sites in hot spots across the country.

The second is a no cost mental health counseling and group support service for tick-borne illness patients. Led by psychiatrists and clinicians with expertise in Lyme disease, we will create a robust training and education platform for mental health providers. This platform will be tailored for different age groups and for caregivers of patients with tick-borne illness.

Please consider helping us fund these two trailblazing initiatives. Contact us via email or by visiting our giving webpage at https://invisible.international/give

Dr. Nevena Zubcevik
nev@invisible.international

Invisible International, a 501(c)(3) nonprofit organization, is dedicated to reducing the suffering and social marginalization associated with invisible illnesses through innovation, education, and data-driven change projects. Invisible’s core team includes board-certified health-care providers in Infectious Disease, Internal Medicine, Family Medicine, Psychiatry, Pharmacy, Pathology, and Physical Medicine and Rehabilitation, many trained at or are affiliated with top-tier universities such as Harvard, Stanford, MIT, Brown, UC Berkeley, UC San Francisco, the US Air Force Academy, University of Virginia, and University of Pittsburgh.