For over 50 years, psychiatrist Robert C Bransfield, MD, has focused on treating patients with some of the most difficult psychiatric conditions, those resistant to conventional therapies. Over time, his clinical work led him to a surprising pattern: many of these patients had a history of infectious disease, particularly Lyme and other tick-borne illnesses. What he found challenges assumptions in both psychiatry and infectious disease.
A Long Road from Infection to Psychiatry
“ I did a study of Lyme, tick borne disease patients and the average patient, and these were well confirmed CDC positive cases. The average patient was nine years post infection, when they ended up in my office seeking treatment for psychiatric symptoms,” Bransfield explained.
Among the patients in his study, the progression from infection to psychiatric issues varied widely. “Now in that group, there would be some that would show rapid progression, and maybe in a year or two, and others that showed up 40 years after infection. So there was a big variability, and some patients had a rapid downhill course. Some patients did well, and then they had some traumatic event, car accident, sometimes delivery or something that was triggered. Maybe was a latent infection that then was reactivated.”
Bransfield added, “And sometimes it’s relapsing remitting course that they have, because there’s such a long delay between the initial infection, or tick borne infection, and then the manifestation of symptoms. And it may not be tick borne, it may be some other way, vector borne, or some other way the infection began.”
Missed Diagnoses and Overlooked Patterns
Because the delay between infection and symptoms can span years or decades, many patients go undiagnosed or misdiagnosed. “It can often be hard to connect the dots to show in a connection between infection and the mental illness or mental impairment,” he said.
“It usually follows a pattern where, when, let’s say, for example, with tick borne infections, there may or may not be a rash, it may or may not be noticed that, just like with syphilis, the rash you see first and then you can have a some people, then they may get nor aligned with a rapid progression neurological symptoms.”
He added, “Those people usually do pretty well because it’s obvious and they get aggressive treatment early. Problem is when people overlook it, they don’t see the connection, or they get inadequate treatment early.”
Treatment Gaps and Co-Infections
Bransfield is critical of early treatment protocols that fail to consider long-term outcomes. “For example, they get one dose of doxycycline. And if you looked at that study, there wasn’t long term follow up whether that was effective with long term symptoms or not, it just reduced the rash. And rash isn’t the problem the long term impairments of the problem.”
Many patients also receive incomplete treatment for complex infections involving multiple pathogens. “Or they may have had a partial treatment, and they may have had an infection with more than one pathogen, an antibiotic that they got may be protected against one pathogen but not another.”
“Many of these infections that are more serious are a combination of Borrelia of different species, Bartonella of different species, Babesia of different species, and often not tested by the usual testing,” he said. “And the tests are of limited value.”
Psychiatry’s Diagnostic Advantage
Bransfield emphasized that psychiatry, more than many other specialties, is uniquely equipped to recognize these patterns, if clinicians are looking for them. “A big thing in making the diagnosis is the clinical presentation. And in psychiatry, we rely particularly on the clinical presentation. If someone has depression or panic attacks, we look at the history, the symptoms, and that’s how we make our diagnosis.”
“In other fields of medicine, sometimes there’s more of an emphasis on blood work. If someone presents me with panic attacks, I don’t say, I’ll do blood work. And if it’s positive, then you have it. If it’s negative, you don’t you have to look at all the evidence in making a diagnosis.”
Flawed Testing and the Need for Clinical Judgment
Bransfield warns against relying too heavily on lab tests, especially those designed around immune markers. “Right now, the lab tests are flawed. They’re very limited. One basic problem is Lyme has evidence of being immunosuppressant and immuno evasive, and therefore there’s a certain limitation of using an immune based test with an infection that’s immune suppressant, and they were never standardized for late stage disease begin with.”
“Therefore we have to look more at direct testing antigen or culture which or PCR, which, usually isn’t done. So a lot of times the diagnosis is missed.”
A Multi-System Illness with Lingering Effects
Tick-borne diseases don’t just affect one system of the body. “I think when it’s like a Lyme case, often it’s multi system. You have, the cognitive, the emotional, the general medical you may have the musculoskeletal symptoms, but those are easier to treat than a neuropsychiatric.”
“Partial treatment may eliminate the musculoskeletal treatments or significantly reduce it, but it may not be enough treatment to prevent later developing neuropsychiatric symptoms,” he said. “That’s the problem is the later development of these symptoms, where there’s often difficulty seeing the connection of how this evolves over time.”
Returning to the Basics of Medicine
Ultimately, Bransfield believes that understanding how these diseases affect patients over time requires physicians to rely on fundamentals. “You have to look at a timeline of how things evolved. What was a person’s state of health before they had this initial infection, and how did that progress over time?”
His advice is simple but important: listen to patients, look beyond the labs, and don’t ignore the possibility that psychiatric symptoms may have infectious roots.
Part 1: Rethinking Mental Illness: The Overlooked Impact of Infection
Part 2: Microbial Infections and Mental Illness: Bridging Psychiatry and Infectious Disease
