Psychosis in Borrelia burgdorferi infection – part II: Case reports

Abstract

In the second part of the article case reports of three patients were presented. All patients were treated for Borrelia infection and all of them developed psychotic disorders. History of each patient was different, as well as the probability of causal relationship between neuroborreliosis and psychosis. The first case concerns a female patient with no former psychiatric history, who developed psychotic episode secondary to neuroborreliosis. Psychotic disorders resolved after antibiotic treatment. In the second case, a male patient was previously twice hospitalized in psychiatric ward due to psychosis. During the third psychiatric hospitalization suspicion of Lyme neuroborreliosis (LNB) was propounded. Patient’s health state improved after combined therapy with antibiotics and antipsychotic drugs. Direct causal relationship between neuroborreliosis and psychosis is ambiguous. The third case concerns a male patient who was initially treated for LNB and tick-borne encephalitis in an infectious diseases ward. During the hospitalization he developed the first in life episode of mania with psychotic features. Second episode of psychosis occurred after a tick bite and a vaccination against tick-borne encephalitis. In this case, coexistence of many diverse factors results in many difficulties in estimating of the probability of the relationship between LNB and episode of mania with psychotic features. Referring to the part I of the article, diagnostic difficulties and differential diagnosis were discussed, as well as the causal relationship between borreliosis and psychosis in each case was estimated.