Bransfield Robert C
Department of Psychiatry, Rutgers-RWJ Medical School, Piscataway, NJ, USA.
Neuropsychiatr Dis Treat. 2017 Jun 16;13:1575-1587. doi: 10.2147/NDT.S136137. eCollection 2017.
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.
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.
A retrospective chart review and epidemiological calculations were performed.
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.
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.
本文旨在研究自杀与莱姆病及相关疾病（LAD）之间的关联。此前尚无期刊文章对该主题进行全面评估。
多篇病例报告及其他参考文献表明自杀风险与LAD之间存在因果关联。户外工作者和退伍军人的自杀风险更高，他们接触LAD的机会也更多。多项研究表明，许多感染以及相关的促炎细胞因子、炎症介导的代谢变化、喹啉酸和谷氨酸变化会改变神经回路，从而增加自杀倾向。LAD中也会出现类似的病理生理过程。
进行了回顾性病历审查和流行病学计算。
LAD导致未感染前无自杀倾向的个体出现自杀行为，有时还会导致杀人行为。感染LAD后出现多种症状与对自身及他人的更高风险相关，尤其是爆发性愤怒、侵入性图像、突然的情绪波动、偏执、分离性发作、幻觉、去抑制、惊恐障碍、快速循环双相情感障碍、人格解体、社交焦虑障碍、药物滥用、过度警觉、广泛性焦虑障碍、泌尿生殖系统症状、慢性疼痛、快感缺失、抑郁、低挫折容忍度和创伤后应激障碍。家人、朋友、医生和医疗系统对LAD的负面态度也可能导致自杀风险增加。通过间接计算，估计美国每年可能有超过1200例因LAD导致的自杀。
LAD中出现的自杀行为导致了大量此前无法解释的自杀事件，并且与免疫介导和代谢变化相关，这些变化会导致精神症状和其他症状，而他人对LAD的负面态度可能会加剧这些症状。一些LAD自杀事件与多种使人衰弱的症状不堪重负有关，另一些则是冲动、怪异且不可预测的。需要更深入的了解以及获取LAD自杀统计数据的直接方法。建议法医、疾病控制与预防中心及其他流行病学组织积极评估LAD与自杀之间的关联。
