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Integrative Psychiatry

Lyme Disease and Psychiatric Disorders with Daniel Kinderlehrer, MD

Did you know that there are two categories on how to recognize Lyme disease? Let’s watch Dr. Daniel Kinderlehrer talk about this and how to also consider Lyme Disease complex in all of your patients.

FULL TRANSCRIPT

In general, we’re talking about two categories.

One is the people with a prior history of acute Lyme disease. So, they presented with, you know, maybe a known tick bite and a rash and they were diagnosed with Lyme disease, they were treated with a course of ten days to three weeks of antibiotics. And either they continued to be symptomatic, or after having gone into remission, now they have a recurrence of symptoms. And this recurrence can be weeks, months or even years after treatment. In other words, the infection goes dormant, but comes back later in the form of chronic symptoms. These people are referred to as having post treatment Lyme disease syndrome or PTLDS.

There’s another category, and that’s people who have no prior knowledge of acute Lyme disease. They never saw a tick, they never saw a rash, but they developed chronic symptoms. I can tell you that that category is much larger than the former category. These people just develop chronic symptoms and are labeled or mislabeled with numerous ICD code diagnoses that are simply misdiagnoses, and among them often are significant psychiatric diagnoses.

Four Central Points: Pattern recognition is essential in diagnosis

Lyme disease complex often presents as a psychiatric illness with major mood disorders, accompanied by physical symptoms. The pattern recognition is essential in diagnosis.

What is this onset of neuropsychiatric complaints and what is it accompanied by? Testing for Lyme disease? Not straightforward. The diagnosis of a chronic infection with Lyme is still not generally accepted by mainstream medicine despite overwhelming evidence.

Lyme endemic areas: Lyme disease has been reported in all 50 states

Lyme disease has been reported in all fifty states, there is no state immune from Lyme disease. But there are areas where it’s much more likely to get it than others. And these are basically states with higher humidity and/or doctors who are more aware and capable of making the diagnosis. So, the Northeast, but that includes the Mid-Atlantic states, and it doesn’t actually doesn’t stop at the Mason-Dixon line. You can keep on going south to Delaware, Maryland, Virginia, and so on. So, areas with high humidity, that includes the Great Lakes states, that includes the Pacific Northwest. At least 50% of my patients are actually from Colorado, and at least 5% of my patients got it in Colorado.

What’s the Pathophysiology?

This is quite interesting. It’s not what we normally think. When we normally think of infections, we think of microbes invading cells and tissue. These microbes in general do not attack our hardware, they don’t invade cells, but rather they attack software. They result in dysregulation of our systems that are supposed to keep us in homeostasis, like our nervous system.

Consider Lyme Disease Complex in all of your patients with:
Chronic anxiety
Chronic depression
Bipolar illness
ODD/rage/irritability
Etc.

Consider Lyme disease complex in your patients with anxiety, depression, perhaps a bipolar presentation, but often a lot of irritability, rage or ODD in kids, along with these other symptoms – fatigue, impaired cognition, pain syndromes, sleep problems. And then if you want to really start to narrow it, the likelihood if they have treatment resistance, why isn’t this person getting better?

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.