Burnout, bipolar or borreliosis? : a diagnostic dilemma behind prolonged disability

The key elements of psychiatric assessment of ability to work are an objective evaluation of function, accurate differential diagnostics, and finding out the clinical and non-clinical reasons behind disability. Here, we present a case with prolonged disability due to disseminated borreliosis that first mimicked burnout, then unipolar depression, and finally, bipolar mood disorder. The important clues of organic neuropsychiatric syndrome were severe cognitive deficits which were disproportionate regarding previous psychiatric diagnoses and a significant and enduring decline of function in the clinical picture. An atypical clinical picture with treatment-refractory psychiatric symptoms should prompt further consultations. Although very rare, the possibility of disseminated borreliosis is worth keeping mind, because the prognosis of late neuropsychiatric, untreated symptoms and prolonged disability is poor.