Psycho-Babble Medication Thread 1098360

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Psychiatrist Article - Infections

Posted by bleauberry on April 27, 2018, at 15:06:19


Robert Bransfield: Lyme disease and psychiatric disorders
My neuro-Borreliosis manifested trough a series of neuro-psychiatric symptoms and systemic illness. I was diagnosed with a stress related disorder, later depression and then a classic psychiatric disease before Lyme disease was diagnosed. My neuro-psychiatric symptoms responded to treatment with antibiotics.
Together with the rise of complex chronic illnesses caused by stealth pathogens, we witness a rise of the invention of so-called somatic disorders. This is of concern to both patients, who are often declared to be suffering from psychiatric illnesses without a proper evaluation of potential biological causes of their symptoms, as well as to their treating physicians. This article from psychiatrist Robert Bransfield provides a better understanding of the brain and body interaction and a critical analysis of the real function of these new somatic syndromes.
Co-source: OnLyme Foundation
I am a psychiatrist practicing in New Jersey, USA. Like many psychiatrists trained in the early 70s my initial training was psychoanalytic. I have always had an interest in attempting to explain and treat the cases we refer to as being treatment resistant. It was clear that neither psychodynamic nor biologically based explanations alone were sufficient to explain these cases and a more comprehensive approach was needed.
First experience with psychiatric complaints caused by infections
Although I am sure I have been seeing psychiatric illness caused by Lyme and tick-borne diseases for my entire career, I became much more involved after an infectious disease colleague referred an extremely ill patient to me.
The patient had a history of Lyme disease and was considered to have been cured with a prior course of antibiotics. After a 3-month psychiatric hospitalization and administering another course of antibiotics, the patients suicidal, homicidal and other psychiatric symptoms improved. This case expanded my diagnostic and treatment capabilities and it was subsequently published.
After researching the literature, consulting with colleagues and seeing many more similar patients, it became clear that much of what we call mental illness is caused by prior infections and chronic infection, including tick-borne diseases and Lyme disease.
Difficulty to understand complexity
I shared my observations of the association between Lyme/tick-borne diseases and mental illness with my infectious disease and medical colleagues and was puzzled when some had difficulty in seeing this association and a few became highly defensive. It was clear that some were unable to think on a more complex level and some had very little training in psychiatry and have great difficulty understanding how general medical conditions and infections can cause psychiatric symptoms.
In attempting to understand their view of the etiology of mental illnesses, it appears many of these physicians believe psychiatric illness can just appear without any biological pathophysiological basis. In addition, many physicians have a belief if their assessment reveals no findings they can understand, it is acceptable to label the symptoms as being subjective, non-specific, medically unexplained, functional and psychiatric.
Rigidity of payment systems
Besides limited problem-solving approaches and flawed view of the interaction between psychological and somatic functioning, healthcare systems in which third party payers aggressively promote rigid diagnostic and treatment criteria adds to the problem. Although rigid criteria may be a viable approach for conditions that are well understood, it is a serious failure when applied to more complex and difficult to understand conditions.
The combination of limited problem-solving capabilities, poor training in the brain-body interface and the rigid design of many third-party payer healthcare systems has created a perfect storm that discriminates against individuals with complex, chronic, costly and poorly understood illnesses who arent aligned with organizations that can neutralize these three hazards.
Systems approach
Complex problems with multiple variables, whether in medicine or any other field, are best understood by using a systems approach. When evaluating a case involving both medical and psychiatric components it is important to first identify if it is psychosomatic, somatopsychic, multisystem illness or some combination of these.
Psychosomatic illness occurs when mental distress results in somatic symptoms. Somatopsychic illness occurs when somatic illness results in mental symptoms. Multi-system illness can result in pathology affecting the brain and body causing both psychiatric and somatic symptoms. The presence of a psychiatric diagnosis does not eliminate the possibility of a comorbid somatic diagnosis or a comorbid somatic diagnosis causing psychiatric symptoms.
The onset of a multisystem illness in a person who is reasonably healthy throughout most of their life is rarely, if ever, associated with a psychogenic etiology. Psychosomatic illnesses invariably begin in childhood, are life-long and vary in intensity depending upon life stressors. A psychiatric diagnosis is never a diagnosis of exclusion. Mental illness is always caused by something, including psychodynamic, neuroimmune, neurochemical, neural network contributors.
Bodily Distress Syndrome in ICD11?
An excellent example of the failure to comprehend the interface between the brain and body is the concept of so called bodily distress syndrome, which is a very distressing concept. The term was never given any validity in any edition of the American Psychiatric Association Diagnostic and Statistical Manual (APA DSM) and was not even recognized as a condition needing further research. Bodily distress syndrome is basically a synonym for Medically Unexplained Symptoms, a concept that is recognized to lack validity in the APA DSM-5.
A term associated with Bodily distress syndrome is Bodily distress disorder. Bodily distress disorder is found in the draft of the 11th version of the International Classification of Diseases (ICD11) currently under development by the World Health Organization (WHO). According to the creators of Bodily distress syndrome, Bodily distress disorder is one of the many somatic disorder terms that fall under the broader category of Bodily distress syndrome.
The proposed definition of Bodily distress disorder is:
the presence of bodily symptoms that are distressing to the individual and excessive attention directed toward the symptoms, which may be manifest by repeated contact with health care providers. If another health condition is causing or contributing to the symptoms, the degree of attention is clearly excessive in relation to its nature and progression. Excessive attention is not alleviated by appropriate clinical examination and investigations and appropriate reassurance. Bodily symptoms and associated distress are persistent, being present on most days for at least several months, and are associated with significant impairment in personal, family, social, educational, occupational or other important areas of functioning. Typically, bodily distress disorder involves multiple bodily symptoms that may vary over time. Occasionally there is a single symptomusually pain or fatiguethat is associated with the other features of the disorder.
This diagnosis is then used to inappropriately lump many conditions into one and may include Fibromyalgia, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Chronic Pain Disorder, Multiple Chemical Sensitivity, Chronic Acute Whiplash Associated Disorders, cardiopulmonary autonomic arousal, gastrointestinal arousal, musculoskeletal tension, concentration difficulties, impairment of memory, excessive fatigue, headache, dizziness, chronic chest pain, chronic pelvic pain, etc.
Serious concerns
This definition raises serious concerns. What is the objective criteria by which excessive attention is determined? How is appropriate clinical examination and investigations and appropriate reassurance determined? How are the thoroughness of the physicians exam and the adequacy of their knowledge, experience and judgment determined? How can we be reassured there are no conflicting interests when a physician makes this diagnosis?
Since psychosomatic symptoms rarely involve multisystem disease that are quite consistent and repetitive over time, how can the illness be defined with typically, bodily distress disorder involves multiple bodily symptoms that may vary over time? Since pain or fatigue can be such disabling conditions they are understandably a reason for significant concern on the part of the patient and how can any appropriate clinical examination and investigations and appropriate reassurance reduce appropriate concern for these symptoms?
MUS
The synonym of bodily distress syndrome, Medically Unexplained Symptoms, is not included in the APA DSM-5 because no medical condition is totally explained or unexplained. Instead, knowledge is on a continuum and all conditions are partially explained to different degrees. This label is impacted by the bias and level of knowledge of anyone calling it unexplained. These symptoms are often unexamined rather than unexplained.
After the medically unexplained symptoms concept was discredited by the American Psychiatric Association, a group with certain belief systems and special interests dealt with this defeat by changing the name of medically unexplained symptoms to bodily distress syndrome.
It appears no psychiatrists and no psychiatric organizations have ever endorsed the bodily distress syndrome concept and the physicians mostly involved are a handful of family physicians in Denmark, but significant financial interests seem to be indicated as the prime movers. Furthermore, there are now significant efforts to have Bodily distress syndrome overlap with the Bodily distress disorder presented in the WHOs ICD11 codes.
To give a brief case example of the hazard of the concept of bodily distress syndrome, I was asked to do a consult with a young female patient in a hospital who was unable to walk. The treating physician could not find anything physical to explain her complaint. In spite of appropriate reassurance, the patients bodily symptoms and distress persisted and were associated with significant impairment.
According to this proposed diagnostic category, she would be given a diagnosis of bodily distress syndrome and her treatment would be psychosocial interventions. I performed a thorough psychiatric examination, a history, a review of systems and a limited general medical examination. The patient did not have la-belle-indifference and there was no psychodynamic explanation to explain her inability to walk. The physical exam demonstrated point tenderness of the right sacroiliac joint with signs of inflammation. Fluid from the sacroiliac confirmed the diagnosis of gonococcal arthritis.
Conflicts of interest
The concern here is that any patient who is more complex and beyond the competency or the thoroughness of the examining physician or may have a condition impacted by the examining physicians conflicts of interest can be easily misdiagnosed as having bodily distress syndrome.
Basically, bodily distress syndrome is a highly subjective, poorly defined and non-specific condition that basically lumps a number of complex, chronic and costly conditions into one diagnosis. There is no evidence to support the diagnostic category, only a group of articles and authors quoting each other. The treatment for bodily distress syndrome is described as being psychosocial interventions.
Dismissing the biological validity of a large number of patients with this diagnosis category would be very harmful to those patients and a threat to human dignity although it would invite abuse by those who are motivated to discriminate against these patients, in particular medical and disability insurance companies and payers or others who may have liability related to the targeted medical impairments.
Complex, poorly understood diseases are often considered to predominately have a psychological basis until proven otherwise. Tuberculosis, hypertension, and stomach ulcers were once considered to have a functional basis. To properly understand the mind/body connection, a knowledge of general medicine, psychiatry, and the systems which link the soma and the brain are required.
No one has a complete knowledge of all fields of medicine. We must, therefore, retain a sense of compassion and humility, recognize that not all diseases have been discovered or properly understood and be aware that much remains to be learned about the brain/body interaction.
Robert Bransfield, Psychiatrist

 

Re: Psychiatrist Article - Infections » bleauberry

Posted by SLS on April 27, 2018, at 17:06:49

In reply to Psychiatrist Article - Infections, posted by bleauberry on April 27, 2018, at 15:06:19

Would you be dismayed to learn that this guy treats most of his psychiatric patients using standard (non-Lyme) treatments?


- Scott

 

Re: Psychiatrist Article - Infections » SLS

Posted by SLS on April 27, 2018, at 20:15:12

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on April 27, 2018, at 17:06:49

> Would you be dismayed to learn that this guy treats most of his psychiatric patients using standard (non-Lyme) treatments?

I contacted Dr. Bransfield. In New Jersey, he estimated that the incidence of Lyme in depressed patients is extremely high. It might be as high as 3 in 10 according to him. This is a huge number, and consistent with what you have reported. Still, I don't believe it. Dr. Bransfield directed me to the following article written in 2002:

----------------------------------------------------------

https://www.ncbi.nlm.nih.gov/pubmed/11823274

----------------------------------------------------------

Still, I don't believe it. Oh. I said that already.


- Scott

 

Re: Psychiatrist Article - Infections » SLS

Posted by Phillipa on April 27, 2018, at 20:32:59

In reply to Re: Psychiatrist Article - Infections » SLS, posted by SLS on April 27, 2018, at 20:15:12

Scott I googled the doctor and the whole internet is articles about this doctor and his association with lymes disease. Nothing negative? Phillipa

 

Re: Psychiatrist Article - Infections » Phillipa

Posted by SLS on April 27, 2018, at 20:56:35

In reply to Re: Psychiatrist Article - Infections » SLS, posted by Phillipa on April 27, 2018, at 20:32:59

> Scott I googled the doctor and the whole internet is articles about this doctor and his association with lymes disease. Nothing negative? Phillipa

There is nothing about him that I find to be negative, even if I have trouble believing his numbers. He is a very compassionate man who has a formidable intellect and extraordinary memory.


- Scott

 

Re: Psychiatrist Article - Infections » SLS

Posted by bleauberry on April 28, 2018, at 7:55:54

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on April 27, 2018, at 17:06:49

> Would you be dismayed to learn that this guy treats most of his psychiatric patients using standard (non-Lyme) treatments?
>
>
> - Scott

No that is perfectly fine in my world. I endorse the usage of psychiatric medications in all cases of Lyme. Improvement of quality of life is the goal and all tools are on the table - ALL TOOLS (key point). The dismay is that most psychiatrists do not do that, generally speaking. They use only finite limited tools. And the result is a lot of treatment resistant patients - who are not actually treatment resistant - who are merely receiving the wrong treatment, missing the target or hitting it only around the edges.

My only dismay is with the vast majority of psychiatrists who accidentally or purposely IGNORE all the rest of the story, the story this particular psychiatrist shared in his article. How the spectacularly fail at connecting disease in the body to mood.

I also have dismay that some readers of the article will totally miss the actual over-riding message of it.

In other words, the author makes it very clear - ABX cleared up his near-psychiatric symptoms. The conventional treatments did not.

 

Re: Psychiatrist Article - Infections » SLS

Posted by bleauberry on April 28, 2018, at 8:00:16

In reply to Re: Psychiatrist Article - Infections » SLS, posted by SLS on April 27, 2018, at 20:15:12

3 out of 10 by this one doctor. 9 out of 10 by 2 other doctors. So in reality the actual data is probably somewhere in the middle of those numbers.

But a serious question in your treatment is this:

WHY do you not want to believe it? That is not a scientific approach. When you automatically form preconceived personal notions in advance, and then discard actual information that discredits your own preconceived notions, that is the opposite of good science.

Science is supposed to be non-biased, non-slanted, objective as possible.

Do you think resistance of information could have anything to do with treatment resistance?

> > Would you be dismayed to learn that this guy treats most of his psychiatric patients using standard (non-Lyme) treatments?
>
> I contacted Dr. Bransfield. In New Jersey, he estimated that the incidence of Lyme in depressed patients is extremely high. It might be as high as 3 in 10 according to him. This is a huge number, and consistent with what you have reported. Still, I don't believe it. Dr. Bransfield directed me to the following article written in 2002:
>
> ----------------------------------------------------------
>
> https://www.ncbi.nlm.nih.gov/pubmed/11823274
>
> ----------------------------------------------------------
>
> Still, I don't believe it. Oh. I said that already.
>
>
> - Scott
>
>

 

Re: Psychiatrist Article - Infections » bleauberry

Posted by SLS on April 28, 2018, at 9:09:27

In reply to Re: Psychiatrist Article - Infections » SLS, posted by bleauberry on April 28, 2018, at 7:55:54

I've already stated my reasons for disbelieving that 9 out of 10 people walking into a psychiatrist's office with depression have Lyme Disease.

You don't like the answers that I have come up with. I don't like the answers that you come up with. You can believe what you like about the fidelity of the majority of science. Freedom of speech operates both ways, of course.

Let's try an experiment. How many people currently have Lyme Disease in the United States of America?


- Scott

 

Re: Psychiatrist Article - Infections » bleauberry

Posted by SLS on April 28, 2018, at 10:09:41

In reply to Re: Psychiatrist Article - Infections » SLS, posted by bleauberry on April 28, 2018, at 7:55:54

Bleauberry:

> ...fail at connecting disease in the body to mood.

I agree that there is a great need for doctors to understand this. I'm glad mine does. One of the first things he did with me was to give me doxycycline for a number of months. I was also on minocycline for 1.5 years.

> I also have dismay that some readers of the article will totally miss the actual over-riding message of it.

Perhaps you can help me to understand this message.

I found Bransfield's article amazing. I just don't understand why he feels that Lyme is so prevalent among psychiatric patients in New Jersey (one of the worst states for Lyme). Anyway, I hope his ideas are taken seriously because they have such universal applications. The man is quite brilliant.

I would still like to know the number of people who have Lyme disease in the USA. Do you have one?


- Scott

 

Re: Psychiatrist Article - Infections

Posted by linkadge on April 29, 2018, at 6:31:58

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on April 28, 2018, at 10:09:41

I'll tell you why 9/10 psychiatric patients don't have Lymes disease...

because there is no geographical correlation between depression and the presence of Lymes carrying tics.

For example, in Canada, the rates of depression / suicide are highest in the arctic regions.

While the incidence of Lymes carrinyg tics has increased in Canada, it is mostly in the southern regions.


Linkadge

 

Re: Psychiatrist Article - Infections » SLS

Posted by bleauberry on May 2, 2018, at 12:46:00

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on April 28, 2018, at 9:09:27

> I've already stated my reasons for disbelieving that 9 out of 10 people walking into a psychiatrist's office with depression have Lyme Disease.

I think there is just resistance. Nothing more than that. The rest of it is fluff. But I was in those shoes myself for many years so I totally get it. It's not right or wrong or good or bad. it's just that it doesn't get anybody to the goal line.

>
> You don't like the answers that I have come up with. I don't like the answers that you come up with. You can believe what you like about the fidelity of the majority of science. Freedom of speech operates both ways, of course.

I have no problem with your answers.

>
> Let's try an experiment. How many people currently have Lyme Disease in the United States of America?

More than you think. A lot more than you think.

Your doctors do not deal with this every day, every patient. Mine do. Mood and pain are the things they become experts at. Their goals are to restore wellness, not to manage illness. If you listen to them, or most any other LLMD out there, you will get the general sense that only 1 in 10 lyme patients is correctly diagnosed. With that in mind, I can answer your question....

10 times more than whatever anybody claims.

You don't trust me. I don't know why. But you don't. And that is ok.

The best I can say is to stay on the meds you are on, but to locate an LLMD within reach, schedule an appointment, with most likely a long 3 - 6 month wait for new patients, and then get your 2nd opinion with about 2 hours of time and $300 cash.

There is no risk and nothing to lose. You either rule things in or rule things out. But number crunching and typing on babble doesn't do either of those things.

I would love to see you get better - way better - and I think it is totally possible within about a 9 month time frame from your first appointment.
imo
>
>
> - Scott

 

Re: Psychiatrist Article - Infections » SLS

Posted by bleauberry on May 2, 2018, at 12:52:05

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on April 28, 2018, at 10:09:41

> Bleauberry:

>
> > I also have dismay that some readers of the article will totally miss the actual over-riding message of it.
>
> Perhaps you can help me to understand this message.

Excellent question. The message is right there in plain view, yet disguised amongst a ton of distractions. The message is this: The author got better - in terms of neuropsychiatric symptoms - with antibiotics but not with conventional treatments. THAT is the message patients and doctors who are struggling should embrace and learn more about.

imo

The fact that you were on some of the tetracyclines for months doesn't say much. Because to treat the whole thing requires 3 antibiotics not 1. The tetras alone will force the bacteria into their cystic forms over weeks and months. And then the tetras are useless. Most of the time you were on them was probably useless. Because the 2nd and 3rd were not on board at the time.

Without studying more on lyme this probably sounds weird I understand.

>
> I found Bransfield's article amazing. I just don't understand why he feels that Lyme is so prevalent among psychiatric patients in New Jersey (one of the worst states for Lyme). Anyway, I hope his ideas are taken seriously because they have such universal applications. The man is quite brilliant.
>
> I would still like to know the number of people who have Lyme disease in the USA. Do you have one?
>
>
> - Scott
>

 

Re: Psychiatrist Article - Infections » bleauberry

Posted by SLS on May 2, 2018, at 13:52:53

In reply to Re: Psychiatrist Article - Infections » SLS, posted by bleauberry on May 2, 2018, at 12:46:00

I trust my doctor, despite my difficulties in embracing his conclusions regarding the prevalence of Lyme Disease in cases of depression within the state of New Jersey. If I had Lyme, I think he would know it by now. The guy is brilliant.


- Scott

 

Re: Psychiatrist Article - Infections » SLS

Posted by bleauberry on May 8, 2018, at 7:55:41

In reply to Re: Psychiatrist Article - Infections » bleauberry, posted by SLS on May 2, 2018, at 13:52:53

> I trust my doctor,

A good relationship is a good start.

>despite my difficulties in embracing his conclusions regarding the prevalence of Lyme Disease in cases of depression within the state of New Jersey.

> If I had Lyme, I think he would know it by now.

How exactly? I've never heard of the ability to rule-in or rule-out Lyme disease on a hunch.

>The guy is brilliant.

Then he should be getting better results. Being brilliant means absolutely nothing without the results that are supposed to go with it. You can't be brilliant and yet not produce brilliance.

just an opinion though

we all have to do the best we can
>
>
> - Scott

 

Re: Psychiatrist Article - Infections » bleauberry

Posted by SLS on May 8, 2018, at 19:24:51

In reply to Re: Psychiatrist Article - Infections » SLS, posted by bleauberry on May 8, 2018, at 7:55:41

> > I trust my doctor,

> A good relationship is a good start.

It is nice to hear this coming from an authority figure.

> > If I had Lyme, I think he would know it by now.

> How exactly? I've never heard of the ability to rule-in or rule-out Lyme disease on a hunch.

1. Who said it was on a hunch? You presume far too much. (I would just remind you that you posted my doctor's article to begin this thread).

2. How would your LLMDs rule-in or rule-out Lyme Disease?

> > The guy is brilliant.

> Then he should be getting better results.

(There's that pesky "should" word).

What are his results? Do you have his statistics? Presumed omniscience is not very attractive.

Even the most brilliant of oncologists can't cure every case of cancer. I guess it depends on how results are measured. Many brilliant researchers in oncology haven't cured a single case.

> Being brilliant means absolutely nothing without the results that are supposed to go with it.

I am not a big fan of the terms "should" or "supposed to". An example would be, "You really should learn how you are supposed to write." I sometimes use the word "should", but only when I'm supposed to.

> You can't be brilliant and yet not produce brilliance.

Brilliance is in the eye of the beholder.

> just an opinion though

Yup.


- Scott


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