The Infectious Disease Society of America, the American Academy of Neurology, and the American Academy of Rheumatology recently proposed Lyme disease guidelines for public comment. These guidelines do not recognize the causal association between Lyme disease and psychiatric illnesses and may contribute to serious national and global consequences, including suicide and violence, if major revisions are not made before its release, according to a review published in Healthcare.
In this review, the researchers reviewed the disclaimer, laboratory testing, and adult and pediatric psychiatric sections of the proposed guidelines and reported perceived flaws.
The review indicated that the proposed disclaimer was more extensive than other guidelines proposed by the Infectious Disease Society of America, and it stated that adherence to guidelines was voluntary, not intended to replace physician judgment, and did not allow for individual patient variations. Researchers found that the guidelines offered no warranty of accuracy or reliability, and that the guidelines held themselves harmless from any losses that may occur when physicians rely upon them for Lyme disease treatment.
Researchers recognized the unreliability of the guidelines’ surveillance case definition, which was being incorrectly used as a diagnostic criterion. They also stated that the recommendations and policies outlined in the disclaimer would subject patients to faulty diagnostic procedures and dangerous, unproven treatments. Researchers opposed recommendations and laws designed to protect physicians who provide dangerous treatments, as well as attempts by the working group to undermine evidence-based Lyme disease treatments and promote guidelines that are clinically unproven.
According to the researchers, one of the most critical flaws of the guidelines was the scientifically unfounded use of surveillance case definition as diagnostic criteria. The guidelines make the incorrect assumption that patients who do not meet Lyme disease surveillance case definition do not meet clinical diagnostic criteria for Lyme disease, and therefore, do not have Lyme disease.
The guidelines also suggest that a positive 2-tiered test be used to diagnose Lyme disease; however, the reviewers stated that this test was highly sensitive, and if results were inaccurate, patients may be subjected to lack of treatment and serious adverse consequences.
Testing for Lyme Disease in Adults With Psychiatric Illness
The proposed guidelines strongly advise against testing for Lyme disease in adults with psychiatric illness; however, results from a number of studies have revealed a causal association between Lyme disease and specific psychiatric illnesses. Previous research has shown that, in Lyme disease, there is a low prevalence of mental illness before infection and that the presence of psychiatric illnesses and comorbidities is more significant postinfection.
Researchers who reviewed the proposed guidelines identified 377 records supporting an association between Lyme disease and psychiatric illness and stated that the proposed guidelines recognized only 4 articles, all of which appeared to be limited to epidemiologic studies that selectively reported outcomes. Researchers also mentioned that this section of the guidelines appeared to be evidence-biased rather than evidence-based.
Testing for Lyme Disease in Children With Developmental, Behavioral, or Psychiatric Disorders
A causal association between Lyme disease and bipolar illness in childhood was recognized in the guidelines’ supplemental materials but was not addressed or included in the guidelines themselves.
The proposed guidelines recommend against routine testing for Lyme disease in children with developmental, behavioral, or psychiatric disorders, stating that no data exist to support a causal relationship between tick-borne infections and behavioral disorders or developmental delays in children; however, the researchers who reviewed the guidelines stated that no references were cited to support these claims and that multiple articles existed that demonstrate a causal relationship between Lyme disease and developmental, behavioral, and psychiatric disorders in childhood.
Bransfield RC, Cook MJ, Bransfield DR. Proposed Lyme disease guidelines and psychiatric illnesses. Healthcare. 2019;7(3):105.