Introduction: Intrusive symptoms are associated with Posttraumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), obsessiveness and suicidal and violent tendencies. They may be the sudden presence of images, thoughts or emotions, sensory perceptions and/or re-experiencing of prior trauma. They may occur spontaneously or be evoked by association. In PTSD the presence of intrusive symptoms result in the defenses of hypervigilance, avoidance and psychic numbing. As a psychiatrist who treats patients with late stage tick-borne diseases (LSTBD), an association is noted between LSTBD and intrusive symptoms. Few articles address this issue (Bär et al., 2005, Fallon et al., 1995 and Stein et al., 1996).
Method: From a database of LSTBD patients representative quotes and cases are presented and 131 cases were reviewed to determine the incidence of intrusive symptoms. These charts were further analyzed for associated symptoms. A literature review was conducted.
Results:Quotes from patients: “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. Episodic, not continuous. These images don’t seem to necessarily be associated with a particular occasion, place or time, but come and invade the privacy of my mind.” “I had intrusive thoughts of killing women with a knife or an axe, then some mechanism in my head was telling me – “kill her – kill her. “Sometimes I had thoughts of killing my sister’s one year old child or my mother.”
Patient A: 56-year-old female with LSTBD. Episodic symptom flares would occur including headaches, neck and joint pain, vertigo, fatigue and cognitive impairments followed one day later by intrusive symptoms with “disgusting obsessions” and suicidal thoughts. Symptoms improved from treatment with intramuscular penicillin, minocycline, topiramate and olanzapine. Her mother was placed on the Liverpool protocol against consent resulting in death which exacerbated intrusive symptoms.
Patient B: 17-year-old female with LSTBD and intrusive symptoms provoking compulsive exercising and banging her arm against the wall to distract her. Escitalopram, lorazepam, topiramate, psychotherapy, minocycline, intramuscular penicillin, anti-inflammatories and intravenous gamma globulin improved symptoms.
Patient C: 31-year-old male with a 12 year history of a progressive multisystemic illness including cognitive impairments, sensory hyperacusis, musculoskeletal pain, fatigue, social anxiety, depression, hallucinations, agitation, guilt, crying spells, disability, feeling worthless and suicidal attempts. There were increasing intrusive symptoms related to prior sex abuse. With considerable outpatient and inpatient psychiatric treatment he continued to deteriorate. He recalled a prior tick bite, had a positive Lyme Western blot and was treated with antibiotics which sometimes exacerbated symptoms (Herxheimer reaction). He committed suicide with an Internet suicide kit.
Patient D: 27-year-old male with a history of an abrupt onset of OCD followed by increasing multisystemic symptoms including intrusive aggressive, bizarre sexual and pedophiliac symptoms; depersonalization; cognitive decline; explosive anger and suicidal and homicidal thoughts. He tested positive for Borrelia, Babesia and Bartonella and was treated with psychotropics and antibiotics.
Patient E: 28-year-old male diagnosed with CNS Lyme disease with a reinfection. He had improvement with short courses of antibiotics based on IDSA guidelines but relapsed with increasing cognitive decline, neurological symptoms, intrusive symptoms and impulsivity. He stalked and killed four females.
Case Review: 131 of cases of LSTBD with a history of complex interactive infections, mostly Borrelia, Babesia, Bartonella, Anaplasma, Ehrlichia and other known and unknown pathogens whose eradication could not be confirmed by current technology, demonstrates 45 (34%) acquired intrusive symptoms (89% aggressive, 18% sexual and altered sexual imagery, 40% other – bizarre, horrific, etc.). Within these 45 cases other symptoms included cognitive 100%, neurological 98%, musculoskeletal 89%, obsessiveness 89%, depersonalization 87%, depression 80%, low frustration tolerance 80%, fatigue 76%, explosive anger 73%, suicidal 69%, social isolation 67%, anhedonia 62%, disinhibition 62%, paranoia 49%, hallucinations 42%, homicidal 31%, OCD 29%, PTSD 13%.
Journal Review: LSTBD causes an increase of chronic inflammatory markers (TNF-alpha, IL-1β, IL-6, CRP) that also correlate with intrusive symptoms, severity of symptom, volumetric brain changes (hippocampal shrinkage) and activation of the basolateral amygdala and ventral hippocampus [Bransfield RC 0012. Copeland 2014. Bob P 2010. Gill J 2008. Heath NM 2013. Zimmerman G 2012. Eraly SA 2014. Ritov. G 2014].
Conclusion: Intrusive symptoms occur in 34% of LSTBD patients which can contribute to causing OCD, PTSD, obsessiveness, and suicidal and violent tendencies. Trauma from chronic illness and other causes can further exacerbate symptoms. Antibiotics, anti-inflammatory strategies, psychotherapy and psychotropics can reduce symptoms and be lifesaving for some patients.