Abstract
Tick-borne borreliosis (Lyme disease) caused by the spirochaete Borrelia burgdorferi is a multisystem infectious disease transmitted through the bites of Ixodes ticks. In addition to the classic manifestations (erythema migrans, arthritis, carditis), the disease is associated with a wide range of neuropsychiatric disorders. One of the key mechanisms of the development of mental disorders in patients with borreliosis is neuroinflammation caused by the immune system’s response to the persistence of Borrelia burgdorferi in brain tissues through the blood-brain barrier. Neuroinflammation is known to lead to activation of microglia, release of pro-inflammatory cytokines (interleukin 6, tumor necrosis factor) and imbalance of neurotransmitter systems, which, in theory, can provoke depression, anxiety disorders and cognitive impairment. This review systematizes modern data on the pathogenesis, clinical features, diagnosis and therapy of mental disorders in borreliosis. It has been found that up to 20 % of patients after antibiotic therapy experience post-treatment Lyme disease syndrome, characterized by chronic fatigue, cognitive deficits, and persistent psychopathological symptoms. The key mechanisms of the development of mental disorders are neuroinflammation caused by the penetration of borrelia through the blood-brain barrier, an imbalance of neurotransmitters (serotonin, dopamine) and autoimmune processes associated with the molecular mimicry of antigens of the pathogen and host tissues. Special attention is paid to epidemiological aspects: in endemic regions, up to 476,000 (USA) and 8,000 (Russia) cases are reported annually, while neuropsychiatric complications often remain undiagnosed due to the limited sensitivity of late-stage serological tests (ELISA, Western blot). Diagnosis requires the integration of neuroimaging techniques (magnetic resonance imaging, positron emission tomography), assessment of pro-inflammatory markers in cerebrospinal fluid, and the use of psychometric scales (the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale). Treatment includes antibiotics (doxycycline, ceftriaxone) in combination with psychopharmacotherapy (antidepressants, antipsychotics). The need for an interdisciplinary approach involving infectious disease specialists, neurologists, and psychiatrists to improve prognosis is emphasized. Research prospects are related to the study of biomarkers of chronic neuroinflammation and the development of personalized therapy regimens.
For citation
Abdulkin MO. Mental disorders in tick-borne borreliosis (Lyme disease): A literature review. USMU Medical Bulletin. 2025;10(2):e00162. (In Russ.). DOI: https://doi.org/10.52420/usmumb.10.2.e00162. EDN: https://elibrary.ru/JNYGYU.
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