Papers by Robert Bransfield
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Psychiatric news, Sep 6, 2002
Potential Uses of Modafinil in Psychiatric Disorders
Modafinil was administered as part of a treatment regimen in patients (N = 237) with a broad spec... more Modafinil was administered as part of a treatment regimen in patients (N = 237) with a broad spectrum of treatmentresistant psychiatric, neurological and general medical disorders accompanied by some combination of excessive sleepiness, fatigue, executive dysfunction, and apathy. In a retrospective chart review of these patients, Clinical Global Impression of Severity (CGI-S) scores were evaluated. Most patients (84.4%) showed improvement in overall clinical condition with modafinil. Most patients tolerated this agent well; the most frequently reported adverse events were overstimulation, insomnia, headaches, and gastrointestinal distress. Modafinil may offer clinical benefit for treatmentresistant hypoarousal symptoms in a number of psychiatric, neurological and general medical conditions.
Healthcare
Adverse Childhood Events (ACE), Post-Traumatic Stress Disorder (PTSD), and infectious encephalopa... more Adverse Childhood Events (ACE), Post-Traumatic Stress Disorder (PTSD), and infectious encephalopathies are associated with immune-mediated diseases. Data supporting this are reviewed, and an integrated hypothesis is provided. All three can be associated with intrusive symptoms and temporal lobe pathology. ACE and PTSD are accompanied by an impaired mental capacity to differentiate external danger vs. safety. Infectious encephalopathies are accompanied by a failure of adaptive immunity and an impaired immune capacity to differentiate internal danger vs. safety. All three conditions are associated with impairments to differentiate danger vs. safety and adapt effectively. There are reciprocal interactions between ACE, PTSD, and infectious encephalopathies with accompanying persistent immune activation. This is associated with immune dysregulation, chronic hyperarousal, activation of the stress response, and impairments of the fear recognition and response neural circuits, hypothalamic–...
Are There Psychoimmune and Infectious Contributors to Violence?
Chronic Infections as Aetiological Factors in Psychiatric Disorders
Lyme and tick-borne diseases: A primer for mental health practitioners
Practice Innovations, 2022
The International Lyme and Associated Diseases Society (ILADS)*
* The International Lyme and Associated Diseases Society (ILADS) is an international multidiscipl... more * The International Lyme and Associated Diseases Society (ILADS) is an international multidisciplinary medical organization of researchers and clinicians. ILADS has created an international forum to facilitate communication, scientific advancement and education of healthcare providers on the subject of Lyme and associated tickborne diseases. This paper was drafted by the authors and approved by the Board of Directors of ILADS. Members who contributed substantially to writing this position statement include:
PET Imaging of Microglia Activation and Infection in Neuropsychiatric Disorders with Potential Infectious Origin
The central nervous system (CNS) is an immunoprivileged location for the possible sequestration o... more The central nervous system (CNS) is an immunoprivileged location for the possible sequestration of latent infections. The presence of pathogens may be involved in the etiology of neuropsychiatric diseases by inducing classical inflammatory responses, hypersensitivity, cellular toxicity, or direct alteration of cellular processes. Infection, persistence, and activation of microbes in the brain are not easy to assess in vivo, and the relation with clinical disease is very difficult to prove. An elegant way to determine an inflammatory response in the brain in vivo is by molecular imaging of microglia activation with [11C]PK11195 and other radiopharmaceuticals that target the translocator protein (TSPO). In this chapter, we summarize the neuroimaging studies that target the TSPO in patients with neuropsychiatric diseases, and we propose positron emission tomography (PET) imaging with radiopharmaceuticals that target the metabolism of infectious agents directly.
Background and Objective: The history of Lyme disease has been characterized by intense controver... more Background and Objective: The history of Lyme disease has been characterized by intense controversy over the diagnosis and treatment of this spirochetal infection. A recent high-profile article by Klempner et al. [1] focused attention on the optimal antibiotic treatment for chronic Lyme disease. Because this research study has generated significant conflict and confusion in the medical community, we undertook a critical analysis of its methodology and conclusions.
Healthcare
There is often difficulty differentiating between psychosomatic, somatopsychic, multisystem illne... more There is often difficulty differentiating between psychosomatic, somatopsychic, multisystem illness, and different degrees of medical uncertainty. Uncommon, complex, and multisystem diseases are commonly misdiagnosed. Two case histories are described, and relevant terms differentiating psychosomatic, somatopsychic, and multisystem illnesses are identified, reviewed, and discussed. Adequate differentiation requires an understanding of the mind/body connection, which includes knowledge of general medicine, psychiatry, and the systems linking the body and the brain. A psychiatric diagnosis cannot be given solely based upon the absence of physical, laboratory, or pathological findings. Medically unexplained symptoms, somatoform disorder, and compensation neurosis are outdated and/or inaccurate terms. The terms subjective, nonspecific, and vague can be used inaccurately. Conversion disorders, functional disorders, psychogenic illness, factitious disorder imposed upon another (Munchausen’...
Many recall the phrase "To know syphilis is to know medicine." Now Lyme disease (Lyme b... more Many recall the phrase "To know syphilis is to know medicine." Now Lyme disease (Lyme borreliosis), the new "great imitator," is the ultimate challenge to the breadth and depth of our knowledge. In psychiatry, we generally treat mental symptoms or syndromes rather than the underlying cause of a disorder.
Healthcare
Many late-stage chronic Lyme disease clinical findings are neuropsychiatric. A total clinical ass... more Many late-stage chronic Lyme disease clinical findings are neuropsychiatric. A total clinical assessment is critical in diagnosis, especially since controversy surrounds the reliability of laboratory testing. The clinical findings of one hundred Lyme disease patients with chronic neuropsychiatric symptoms were entered into a database. The prevalence of each clinical finding pre-infection and post-infection was compared and calculated within the 95% confidence interval. Patients had minimal symptoms pre-infection, but a high post-infection prevalence of a broad spectrum of acquired multisystem symptoms. These findings included impairments of attention span, memory, processing, executive functioning, emotional functioning, behavior, psychiatric syndromes, vegetative functioning, neurological, musculoskeletal, cardiovascular, upper respiratory, dental, pulmonary, gastrointestinal, genitourinary, and other symptoms. The most prevalent symptoms included sustained attention impairments, b...
Antibiotics
Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitiou... more Objective: Chronic Lyme disease has been a poorly defined term and often dismissed as a fictitious entity. In this paper, the International Lyme and Associated Diseases Society (ILADS) provides its evidence-based definition of chronic Lyme disease. Definition: ILADS defines chronic Lyme disease (CLD) as a multisystem illness with a wide range of symptoms and/or signs that are either continuously or intermittently present for a minimum of six months. The illness is the result of an active and ongoing infection by any of several pathogenic members of the Borrelia burgdorferi sensu lato complex (Bbsl). The infection has variable latency periods and signs and symptoms may wax, wane and migrate. CLD has two subcategories, CLD, untreated (CLD-U) and CLD, previously treated (CLD-PT). The latter requires that CLD manifestations persist or recur following treatment and are present continuously or in a relapsing/remitting pattern for a duration of six months or more. Methods: Systematic revie...
Healthcare
The Infectious Disease Society of America, American Academy of Neurology, and American Academy of... more The Infectious Disease Society of America, American Academy of Neurology, and American Academy of Rheumatology jointly proposed Lyme disease guidelines. Four areas most relevant to psychiatry were reviewed—the disclaimer, laboratory testing, and adult and pediatric psychiatric sections. The disclaimer and the manner in which these guidelines are implemented are insufficient to remove the authors and sponsoring organizations from liability for harm caused by these guidelines. The guidelines and supporting citations place improper credibility upon surveillance case definition rather than clinical diagnosis criteria. The guidelines fail to address the clear causal association between Lyme disease and psychiatric illnesses, suicide, violence, developmental disabilities and substance abuse despite significant supporting evidence. If these guidelines are published without very major revisions, and if the sponsoring medical societies attempt to enforce these guidelines as a standard of car...
Healthcare
There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. T... more There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. This article draws from databases, search engines and clinical experience to review current information on LB. LB causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity which may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, m...
Neuropsychiatric Disease and Treatment
Background: No study has previously analyzed aggressiveness, homicide, and Lyme disease (LD). Mat... more Background: No study has previously analyzed aggressiveness, homicide, and Lyme disease (LD). Materials and methods: Retrospective LD chart reviews analyzed aggressiveness, compared 50 homicidal with 50 non-homicidal patients, and analyzed homicides. Results: Most aggression with LD was impulsive, sometimes provoked by intrusive symptoms, sensory stimulation or frustration and was invariably bizarre and senseless. About 9.6% of LD patients were homicidal with the average diagnosis delay of 9 years. Postinfection findings associated with homicidality that separated from the non-homicidal group within the 95% confidence interval included suicidality, sudden abrupt mood swings, explosive anger, paranoia, anhedonia, hypervigilance, exaggerated startle, disinhibition, nightmares, depersonalization, intrusive aggressive images, dissociative episodes, derealization, intrusive sexual images, marital/family problems, legal problems, substance abuse, depression, panic disorder, memory impairments, neuropathy, cranial nerve symptoms, and decreased libido. Seven LD homicides included predatory aggression, poor impulse control, and psychosis. Some patients have selective hyperacusis to mouth sounds, which I propose may be the result of brain dysfunction causing a disinhibition of a primitive fear of oral predation. Conclusion: LD and the immune, biochemical, neurotransmitter, and the neural circuit reactions to it can cause impairments associated with violence. Many LD patients have no aggressiveness tendencies or only mild degrees of low frustration tolerance and irritability and pose no danger; however, a lesser number experience explosive anger, a lesser number experience homicidal thoughts and impulses, and much lesser number commit homicides. Since such large numbers are affected by LD, this small percent can be highly significant. Much of the violence associated with LD can be avoided with better prevention, diagnosis, and treatment of LD.
There is increasing evidence and recognition that Lyme borreliosis, and other associated tick-bor... more There is increasing evidence and recognition that Lyme borreliosis, and other associated tick-borne diseases (LB/TBD) cause mental symptoms. Data was drawn from databases, search engines and clinical experience to review current information on LB/TBD. LB/TBD infections cause immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity and may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a comprehensive psychiat...
Neuropsychiatric Disease and Treatment
Purpose: The aim of this paper is to investigate the association between suicide and Lyme and ass... more Purpose: The aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject. Introduction: Multiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD. Method: A retrospective chart review and epidemiological calculations were performed. Results: LAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital-urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year. Conclusion: Suicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.
Intrusive symptoms and infectious encephalopathies
Neurology, Psychiatry and Brain Research, 2016
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Papers by Robert Bransfield