What psychiatric illness/disorder would you say has the worst overall prognosis/outcomes?

[futureapppsy2]

The research on this seems to show that it largely depends on the metric you use to measure outcomes (e.g., suicide rate, overall mortality, self-related QOL, functioning [and what domain of functioning], disability-adjusted life years [I have serious issues with that concept, but that's another topic], time without hospitalization, etc), so I'm curious, based on the overall gestalt of "outcomes" what disorder(s) would you consider to have the worst outcomes and why?

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[SmallBird]

The research on this seems to show that it largely depends on the metric you use to measure outcomes (e.g., suicide rate, overall mortality, self-related QOL, functioning [and what domain of functioning], disability-adjusted life years [I have serious issues with that concept, but that's another topic], time without hospitalization, etc), so I'm curious, based on the overall gestalt of "outcomes" what disorder(s) would you consider to have the worst outcomes and why?

Trichotillomania by proxy.

 

[Sushirolls]

Anorexia, Alcohol UD, Opioid UD could each be argued from different angles. And I suspect the top 3.

But if Dementia allowed to toss its ring into the hat, it stands a fighting chance.

I think the sleeper most don't consider is meth. The family destruction. The 'parents' that pimp their kids out. The paranoia, the run ins with law, dealers, victims they are robbing.

 

[futureapppsy2]

I’d put BPD as one of them due to its mix of suffering for the patient and suffering for a lot of people surrounding the patient.

 

[futureapppsy2]

But if Dementia allowed to toss its ring into the hat, it stands a fighting chance.

If we include dementia (though I’d put that firmly in neurology, myself), I’d say it may be unequivocally the worst—horrifying to witness, incredibly expensive, debilitating, untreatable, and always fatal.

 

[calvnandhobbs68]

I’d put BPD as one of them due to its mix of suffering for the patient and suffering for a lot of people surrounding the patient.

I wouldn’t count it in having the “worst outcomes” overall though considering a significant number of patients with BPD have symptoms remit.

The Lifetime Course of Borderline Personality Disorder

Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption. This paper reviews the course of BPD throughout life, including childhood, adolescence, ...

www.ncbi.nlm.nih.gov

Ex. During a 10-year period of follow-up, 91% achieve at least a 2-month remission, with 85% achieving remission for 12 months or longer

 

[Ceke2002]

Anorexia, Alcohol UD, Opioid UD could each be argued from different angles. And I suspect the top 3.

But if Dementia allowed to toss its ring into the hat, it stands a fighting chance.

I think the sleeper most don't consider is meth. The family destruction. The 'parents' that pimp their kids out. The paranoia, the run ins with law, dealers, victims they are robbing.

Anorexia and Opioid UD for sure, from the point of view that it's just a you know what to treat and recover from, as well as the higher risk of death or lifelong disability.

I do think meth flies under the radar a tad, because when you put its addictive potential up against something like heroin it's not in the same ball park. Trouble with that though is it might then lead people to think meth addiction is somehow lesser in destructive potential than something like heroin addiction, which I don't think is necessarily the case (just speaking personally I never know saw one of my heroin addicted friends need to be piled on and restrained to stop them jumping out a second story window, because they were in a state of florid psychosis). I do also think there's a stigma related to classist attitudes when looking at something like meth addiction, and therefore a tendency to down play the destruction when placed against other forms of addiction.

Dementia just totally blows. There's a reason I agreed to stopping treatment for sepsis and have Mum placed onto hospice, nobody should be forced to live with that low a quality of life.

 

[Fan_of_Meehl]

Anorexia, Alcohol UD, Opioid UD could each be argued from different angles. And I suspect the top 3.

But if Dementia allowed to toss its ring into the hat, it stands a fighting chance.

I think the sleeper most don't consider is meth. The family destruction. The 'parents' that pimp their kids out. The paranoia, the run ins with law, dealers, victims they are robbing.

Alcoholism splits pretty hard, though with a not insubstantial minority finally getting sober and turning things around--sometimes spectacularly--at a certain point.

 

[Celexa]

Dementia in all of its flavors definitely wins if the criteria is the diagnosis I most dread having to give. On the consult service it comes up regularly where we are consulted for psychiatric symptoms that are secondary to dementia. Sometimes that means we are the first people to make the diagnosis. It sucks every time.

 

[Merovinge]

Early onset schizophrenia would be high up on the list. The lack of time spent prior to chronic psychosis makes ongoing functioning very difficult. The real answer is clearly OUD in present day America, with almost every opioid option having a highly variable amount of Fentenyl I don't think anything else comes close. I believe when Krocodile was a thing average time to death from first use was only a few years.

 

[smalltownpsych]

I have always heard the stats say anorexia has the worst recovery rate. Not my area of expertise so not sure what that means more specifically. Substance use disorders stats are pretty grim with like only 20 to 25 recovering, but as metioned earlier when they do recover the prognosis can be excellent. Probably the disorders with the biggest upside. Schizophrenia can be disabling, but in the absence of a substance use disorder,I typically see fairly good outcomes. Co-occurring substance use disorder seems the worst to me. Some of the most difficult patients I have personally had to work with or try to help have been young adults with Reactive Attachment Disorder. Borderline PD is my favorite disorder to treat and I get good outcomes with that unless you add in another cooccuring disorder such as anorexia or substance use.

 

[Ceke2002]

I have always heard the stats say anorexia has the worst recovery rate. Not my area of expertise so not sure what that means more specifically. Substance use disorders stats are pretty grim with like only 20 to 25 recovering, but as metioned earlier when they do recover the prognosis can be excellent. Probably the disorders with the biggest upside. Schizophrenia can be disabling, but in the absence of a substance use disorder,I typically see fairly good outcomes. Co-occurring substance use disorder seems the worst to me. Some of the most difficult patients I have personally had to work with or try to help have been young adults with Reactive Attachment Disorder. Borderline PD is my favorite disorder to treat and I get good outcomes with that unless you add in another cooccuring disorder such as anorexia or substance use.

There was a 5 year study done in South Australia that seemed to show better outcomes for those diagnosed with Bulimia or what was then termed EDnos as opposed to those with Anorexia Nervosa. 74% of Bulimics in the study had no diagnosable ED at the end of 5 years, 78% for EDnos and 56% for AN, with a small proportion in each group having poor Morgan Russel Hayward scores at outcome.

I actually participated in this study. I've just requested the full text to see if I recognise myself anywhere in it. I'm fairly sure I was in the 'not recovered, poor scores at outcome' group. It would actually be interesting if they had a run up a further follow up study at the 10 and 15 year mark as well.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)04406-8/fulltext

 

[futureapppsy2]

I wouldn’t count it in having the “worst outcomes” overall though considering a significant number of patients with BPD have symptoms remit.

The Lifetime Course of Borderline Personality Disorder

Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption. This paper reviews the course of BPD throughout life, including childhood, adolescence, ...

www.ncbi.nlm.nih.gov

Ex. During a 10-year period of follow-up, 91% achieve at least a 2-month remission, with 85% achieving remission for 12 months or longer

True, but I would also consider the high rates of lack of treatment engagement /treatment-seeking/ability to get EBP and the level of distress inflicted on loved ones in that. Good response to evidence-based treatment is great, but the percentage of people who get that treatment is also important. Lots of areas have, at most, a mid-level who teaches basic mindfulness skills versus access to full-model DBT.

 

[futureapppsy2]

There was a 5 year study done in South Australia that seemed to show better outcomes for those diagnosed with Bulimia or what was then termed EDnos as opposed to those with Anorexia Nervosa. 74% of Bulimics in the study had no diagnosable ED at the end of 5 years, 78% for EDnos and 56% for AN, with a small proportion in each group having poor Morgan Russel Hayward scores at outcome.

I actually participated in this study. I've just requested the full text to see if I recognise myself anywhere in it. I'm fairly sure I was in the 'not recovered, poor scores at outcome' group. It would actually be interesting if they had a run up a further follow up study at the 10 and 15 year mark as well.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)04406-8/fulltext

Anorexia also has a much better recovery rate if it can be treated early with full prolonged nutritional restoration, usually involving family-based therapy. FBT seems to be changing the game for adolescent and younger AN outcomes, if a family is willing/able to do it.

 

[Ceke2002]

Anorexia also has a much better recovery rate if it can be treated early with full prolonged nutritional restoration, usually involving family-based therapy. FBT seems to be changing the game for adolescent and younger AN outcomes, if a family is willing/able to do it.

I can't speak personally to early intervention, nor family therapy (my family was simply not suited for that), but prolonged nutritional restoration was definitely a game changer for me, and something I would highly recommend in AN treatment. I used to buy into the old school view that if you treat the psychological symptoms, then somehow nutrition and weight restoration would follow. In all honesty that was just my way of remaining entrenched in the disorder, whilst pretending I was doing something about it. It wasn't until I eventually committed to full recovery, which included prolonged weight and nutritional restoration, that I realised trying to truly deal with the psychological side of Anorexia while your mind and body is starved just doesn't work.

 

[futureapppsy2]

I can't speak personally to early intervention, nor family therapy (my family was simply not suited for that), but prolonged nutritional restoration was definitely a game changer for me, and something I would highly recommend in AN treatment. I used to buy into the old school view that if you treat the psychological symptoms, then somehow nutrition and weight restoration would follow. In all honesty that was just my way of remaining entrenched in the disorder, whilst pretending I was doing something about it. It wasn't until I eventually committed to full recovery, which included prolonged weight and nutritional restoration, that I realised trying to truly deal with the psychological side of Anorexia while your mind and body is starved just doesn't work.

Family therapy and family-based therapy for AN are two very different things. FBT focuses on involving the parents in supporting long-term weight restoration and exposure to fear foods, etc (basically, countering AN behaviors) whereas family therapy--which is largely ineffective for people with active AN--focuses on family dynamics.

 

[Stagg737]

In general, I'd say neurodegenerative disorders are the worst. Huntington's, LBD, FTD, Wilson's, etc. Take your pick. They're all a relatively slow decline into oblivion that devastates everyone around the patient as much or more than the patient. One could argue that these aren't really "psych" disorders, but I'm consults and like Celexa am very often involved in these patient's care, whether that means identifying likely early cases or managing the agitation or severe cognitive symptoms later on. Probably my least favorite patients to treat and the biggest reason I didn't go into neuro.

In terms of purely our field, I agree that SUD + psychotic disorder is way up there. The people I see frequently in the ER for actual psych issues are the severe PD patients (often BPD + substance) and schizo-something + SUD. Patients whose brains are already screwed with a primary psychotic disorder with accelerated rate of chronic decompensation with the ongoing substance use is just another decline into oblivion.

I have always heard the stats say anorexia has the worst recovery rate. Not my area of expertise so not sure what that means more specifically. Substance use disorders stats are pretty grim with like only 20 to 25 recovering, but as metioned earlier when they do recover the prognosis can be excellent. Probably the disorders with the biggest upside. Schizophrenia can be disabling, but in the absence of a substance use disorder,I typically see fairly good outcomes. Co-occurring substance use disorder seems the worst to me. Some of the most difficult patients I have personally had to work with or try to help have been young adults with Reactive Attachment Disorder. Borderline PD is my favorite disorder to treat and I get good outcomes with that unless you add in another cooccuring disorder such as anorexia or substance use.

Anorexia still has the highest rates of all-cause mortality, or so all the boards studying resources say.

 

[Ceke2002]

Family therapy and family-based therapy for AN are two very different things. FBT focuses on involving the parents in supporting long-term weight restoration and exposure to fear foods, etc (basically, countering AN behaviors) whereas family therapy--which is largely ineffective for people with active AN--focuses on family dynamics.

Oh yeah, no I got that. Sorry if I didn't make that clear. I was referring to both types of therapy, just probably a bit clunkily. Appreciate the insights though.

 

[Styrene]

Severe carfentanyl use disorder

 

[clozareal]

I would assume you're only talking about psychiatric diagnoses.

I agree with Anorexia Nervosa and the substance use disorders above as the highest mortality rates.

Undiagnosed/untreated catatonia is up there as well.

Severe intellectual disability and severe autism.

Disorders that appear early in life can accrue more DALYs simply because they affect people for a longer period. I guess more common disorders would also have higher total DALYs even if they're less severe on an individual level.

 

[Stagg737]

I would assume you're only talking about psychiatric diagnoses.

I agree with Anorexia Nervosa and the substance use disorders above as the highest mortality rates.

Undiagnosed/untreated catatonia is up there as well.

Severe intellectual disability and severe autism.

Disorders that appear early in life can accrue more DALYs simply because they affect people for a longer period. I guess more common disorders would also have higher total DALYs even if they're less severe on an individual level.

I could see that, but I don't think it's as bad as others. Even though those people will never be functional and require high levels of support, getting them in the right system early relieves a lot of stress of the surrounding family and the expectations of poor prognosis are always there. psychotic disorders and dementia imo are much worse because many of these people are high functioning and lead completely normal lives until symptoms develop and it turns families upside down. I think the conversations with the parents of previously high functioning kids who develop schizophrenia and children of parents with dementia (especially when it starts early) are much more difficult than those of parents with kids with ID.

 

[Merovinge]

I could see that, but I don't think it's as bad as others. Even though those people will never be functional and require high levels of support, getting them in the right system early relieves a lot of stress of the surrounding family and the expectations of poor prognosis are always there. psychotic disorders and dementia imo are much worse because many of these people are high functioning and lead completely normal lives until symptoms develop and it turns families upside down. I think the conversations with the parents of previously high functioning kids who develop schizophrenia and children of parents with dementia (especially when it starts early) are much more difficult than those of parents with kids with ID.

I have seen a few cases of horrific regressive autism where kids were higher functioning for some number of years then dropped dramatically in functioning, s/p $1,000,000 workup without cause found. That's so heartbreaking for family's, I had one show me videos of their child who looked like a normal kid and when I knew them they were non-verbal and only limitedly able to do ADLs. I completely agree that expectations make a huge difference and a real part of the soul crushing nature of schizophrenia when it hits someone who was previously very high functioning and without signs of it coming.

 

[Merovinge]

In general, I'd say neurodegenerative disorders are the worst. Huntington's, LBD, FTD, Wilson's, etc. Take your pick. They're all a relatively slow decline into oblivion that devastates everyone around the patient as much or more than the patient. One could argue that these aren't really "psych" disorders, but I'm consults and like Celexa am very often involved in these patient's care, whether that means identifying likely early cases or managing the agitation or severe cognitive symptoms later on. Probably my least favorite patients to treat and the biggest reason I didn't go into neuro.

In terms of purely our field, I agree that SUD + psychotic disorder is way up there. The people I see frequently in the ER for actual psych issues are the severe PD patients (often BPD + substance) and schizo-something + SUD. Patients whose brains are already screwed with a primary psychotic disorder with accelerated rate of chronic decompensation with the ongoing substance use is just another decline into oblivion.


Anorexia still has the highest rates of all-cause mortality, or so all the boards studying resources say.

AN has a very high all cause mortality both for the portion that die as a direct cause of lack of adequate nutrition and those that die of suicide. However modern data is showing OUD to have a higher mortality than AN. I am too busy at work today to provide the citations but I work with specialists in addiction and eating disorders and they would all agree.

 

[comp1]

Nothing even comes close to dementia. Excluding that...huffing? I mean it leads to dementia eventually. Worse than meth in my opinion, at least in terms of prognosis.

 

[Therapist4Chnge]

AN has a very high all cause mortality both for the portion that die as a direct cause of lack of adequate nutrition and those that die of suicide. However modern data is showing OUD to have a higher mortality than AN. I am too busy at work today to provide the citations but I work with specialists in addiction and eating disorders and they would all agree.

Eating disorders, sub use disorders, and degenerative neuro conditions would be my top 3 categories. All are quite treatment resistant, though for different reasons. I saw mostly adult ED cases, mostly numerous relapses, and almost all had dysfunctional families (often w other EDs active in the family). I had countless mother/daughter, multiple sibling, and some step-mom + daughter combos present, though not at the same treatment center and time. I spent a number of years assessing EDs and not only is comorbidity with other dxs a challenge, the health impact cannot be underestimated. Heart failure because the body literally ate itself is not exactly an easy fix. Risk of suicide was also quite high. EDs are ruthless.

 

[Stagg737]

I have seen a few cases of horrific regressive autism where kids were higher functioning for some number of years then dropped dramatically in functioning, s/p $1,000,000 workup without cause found. That's so heartbreaking for family's, I had one show me videos of their child who looked like a normal kid and when I knew them they were non-verbal and only limitedly able to do ADLs. I completely agree that expectations make a huge difference and a real part of the soul crushing nature of schizophrenia when it hits someone who was previously very high functioning and without signs of it coming.

I could see that. But even in those cases the kids are still typically pretty young when the regression occurs, and expectations can be dampened. Not like a fully functioning high school senior on a scholarship or a young professional with young kids who has a first break. I still like working with first break cases (especially mania), but educating family who have no real exposure to SMI prior to that is almost always devastating.

AN has a very high all cause mortality both for the portion that die as a direct cause of lack of adequate nutrition and those that die of suicide. However modern data is showing OUD to have a higher mortality than AN. I am too busy at work today to provide the citations but I work with specialists in addiction and eating disorders and they would all agree.

I'd be interested in that data if you get the time and would be curious how much of the mortality for OUD is due to accidental overdoses from stuff like fentanyl and now xylazine vs any other cause.

 

[splik]

Anorexia still has the highest rates of all-cause mortality, or so all the boards studying resources say.

Anorexia has a standardized mortality of 5.86 for 1000 person years, whereas OUD has an SMR of 10.3

 

[whopper]

Dementia. Nothing treats it well.
Child Disintegrative Disorder-no one knows WTF even causes it. There's no meds with good evidence to treat it.

 

[Stagg737]

Anorexia has a standardized mortality of 5.86 for 1000 person years, whereas OUD has an SMR of 10.3

Interesting because NIH says AN has the highest mortality rates but lists a lower standardized mortality (<4). I wonder if most of these sources don’t consider OUD to be a “psychiatric” disorder…

Anorexia nervosa and the long‐term risk of mortality in women

www.ncbi.nlm.nih.gov

 

[futureapppsy2]

I wonder if most of these sources don’t consider OUD to be a “psychiatric” disorder…

That’s probably the case, especially given that NIH has different institutes for mental health and addiction.

 

[clausewitz2]

That’s probably the case, especially given that NIH has different institutes for mental health and addiction.

Even better, different instituties for addiction and 'alcohol abuse', because those are totally and completely unrelated.

 

[Ceke2002]

Interesting because NIH says AN has the highest mortality rates but lists a lower standardized mortality (<4). I wonder if most of these sources don’t consider OUD to be a “psychiatric” disorder…

Anorexia nervosa and the long‐term risk of mortality in women

www.ncbi.nlm.nih.gov

Unfortunately, even if even if it's not said outright, I do think OUD tends to be seen more as a moral failing of the person, and less as an actual disorder that requires understanding and treatment.

 

[Ceke2002]

Eating disorders, sub use disorders, and degenerative neuro conditions would be my top 3 categories. All are quite treatment resistant, though for different reasons. I saw mostly adult ED cases, mostly numerous relapses, and almost all had dysfunctional families (often w other EDs active in the family). I had countless mother/daughter, multiple sibling, and some step-mom + daughter combos present, though not at the same treatment center and time. I spent a number of years assessing EDs and not only is comorbidity with other dxs a challenge, the health impact cannot be underestimated. Heart failure because the body literally ate itself is not exactly an easy fix. Risk of suicide was also quite high. EDs are ruthless.

The Anorexia Nervosa Genetics Initiative (ANGI) study came up with some interesting results in regard to identifying around 8 new genome regions strongly associated with AN. There was a follow up study as well, but I haven't heard any updates on that (I was one of the study participants). I would've been in the family member(s) + patient with ED category as well (mother who cycled through periods of AN, BED, and COE, and an auntie with severe and chronic AN). Agree as well with not underestimating health impacts. I'm fully weight and nutrition restored, and around 90-95% psychologically recovered, but in terms of long term health issues I really did a number on myself (digestive disorders, tooth loss, nerve damage).

 

[Stagg737]

Unfortunately, even if even if it's not said outright, I do think OUD tends to be seen more as a moral failing of the person, and less as an actual disorder that requires understanding and treatment.

Societally, yes. But in the domains of research and academics through which stuff like this is defined not so much. I could see them defining SUDs as "medical" and not "psychiatric" disorders, though it's just somewhat strange to me as treating SUDs is a huge part of our field.

 

[smalltownpsych]

Societally, yes. But in the domains of research and academics through which stuff like this is defined not so much. I could see them defining SUDs as "medical" and not "psychiatric" disorders, though it's just somewhat strange to me as treating SUDs is a huge part of our field.

What is funny is that I have a high level of expertise and knowledge in addiction and agree that it needs treatment and is not a moral failing and I also separate it out from other mental disorders. It actually makes sense from a clinical stance for a number of reasons, one right off the top of my head is how level of impairment can fluctuate so rapidly. Sober up for a few days or weeks and many substance abusers can be incredibly high functioning and even during the addiction itself can function at very high levels. I also see a big difference between my patients with co-occuring disorders and those with straight-up substance use and don’t think that they mix very well in treatment.
so on the one hand, I definitely see it as a mental health disorder and we should be involved in treatment and research and on the other I see it as different. Good thing I have moved past dualism and live in the world of both/and pr maybe I’m just misguided and confused. 😉

 

[Merovinge]

Societally, yes. But in the domains of research and academics through which stuff like this is defined not so much. I could see them defining SUDs as "medical" and not "psychiatric" disorders, though it's just somewhat strange to me as treating SUDs is a huge part of our field.

That's so bizarre to me. The majority of addictionologists are psychiatrists (ABAM aside), we are the only field that has requirements around learning/treating it during training (that I know of), and a huge majority of patient's with addiction suffered from pre-existing psychiatric disorders, not counting the number of psychiatric disorders that can be caused by addiction.

Sorry to make a classic test question change but OUD clearly is the leading mortality psychiatric disorder at this time. And given how easily chemicals are flowing cross boarders and Fentenyl is being made, I don't see that changing anytime soon.

 

[Mad Jack]

Nothing even comes close to dementia. Excluding that...huffing? I mean it leads to dementia eventually. Worse than meth in my opinion, at least in terms of prognosis.

I once heard a story from a huffer that he stopped after his cousin ended up severely disabled huffing gasoline and he realized he was getting high on brain damage

 

[PsyDr]

1) creutzfeldt-jakob behavioral variant.

You ate a burger sometime in the last several decades. Maybe someone cut a corner and ordered beef from a shady supplier. Cooking doesn’t help, because the prions are heat resistant to ~300C. And you could already have this inside you right now, because the incubation period ranges from 5-42 years. Initial symptoms can include withdrawal from social activities, and depression. You start isolating yourself from friends and family, until you’re alone. If you’re super unlucky, the next thing to fail is your vision and memory, so you can’t coordinate getting help. Not that it matters because the disease has a 100% fatality rate. But it’s a slow process.

2) @smalltownpsych Pickard, H. (2017). "Responsibility without Blame for Addiction." Neuroethics 10(1): 169-180.

I think @clausewitz2 has a better reference in some of his posts.

 

[Mad Jack]

1) creutzfeldt-jakob behavioral variant.

You ate a burger sometime in the last several decades. Maybe someone cut a corner and ordered beef from a shady supplier. Cooking doesn’t help, because the prions are heat resistant to ~300C. And you could already have this inside you right now, because the incubation period ranges from 5-42 years. Initial symptoms can include withdrawal from social activities, and depression. You start isolating yourself from friends and family, until you’re alone. If you’re super unlucky, the next thing to fail is your vision and memory, so you can’t coordinate getting help. Not that it matters because the disease has a 100% fatality rate. But it’s a slow process.

2) @smalltownpsych Pickard, H. (2017). "Responsibility without Blame for Addiction." Neuroethics 10(1): 169-180.

I think @clausewitz2 has a better reference in some of his posts.

I saw a case of vCJD once. Third member of the family to have it, all of them had rapid decline within 2 years of onset of symptoms. Worst part was, she knew what was coming, because she'd seen it twice before. No one in the family aside from this one generation had it, so my bet was on bad meat they had shared at some point in the past. There were some hunters in the family, but no travel to any area where Mad Cow was ever reported, so my theory was wild game meat that had been split up amongst the family after a kill, but we'll never know for sure. Needless to say, it put me off of venisom for the rest of my life

 

[clozareal]

1) creutzfeldt-jakob behavioral variant.

You ate a burger sometime in the last several decades. Maybe someone cut a corner and ordered beef from a shady supplier. Cooking doesn’t help, because the prions are heat resistant to ~300C. And you could already have this inside you right now, because the incubation period ranges from 5-42 years. Initial symptoms can include withdrawal from social activities, and depression. You start isolating yourself from friends and family, until you’re alone. If you’re super unlucky, the next thing to fail is your vision and memory, so you can’t coordinate getting help. Not that it matters because the disease has a 100% fatality rate. But it’s a slow process.

how does this not cause more illness anxiety disorder or OCD about being infected?

 

[PsyDr]

how does this not cause more illness anxiety disorder or OCD about being infected?

It has up to a 42 year incubation period..... you could already have it. There was a confirmed US outbreak of 26 cases in 2018.

 

[calvnandhobbs68]

It has up to a 42 year incubation period..... you could already have it. There was a confirmed US outbreak of 26 cases in 2018.

I mean this whole thing is a little dramatic. Are you sure you mean vCJD vs sCJD?

From the CDC website (which was reviewed in 2021):

Four cases of vCJD have been reported from the United States. There is strong evidence that suggests that two of the four cases were exposed to the BSE agent in the United Kingdom and that the third was exposed while living in Saudi Arabia

There has never been a case of vCJD that did not have a history of exposure within a country where the cattle disease, BSE, was occurring.

vCJD Cases Reported in the US | Variant Creutzfeldt-Jakob Disease, Classic (CJD) | Prion Disease | CDC

www.cdc.gov

 

[clozareal]

I mean this whole thing is a little dramatic. Are you sure you mean vCJD vs sCJD?

From the CDC website (which was reviewed in 2021):

Four cases of vCJD have been reported from the United States. There is strong evidence that suggests that two of the four cases were exposed to the BSE agent in the United Kingdom and that the third was exposed while living in Saudi Arabia

There has never been a case of vCJD that did not have a history of exposure within a country where the cattle disease, BSE, was occurring.

vCJD Cases Reported in the US | Variant Creutzfeldt-Jakob Disease, Classic (CJD) | Prion Disease | CDC

www.cdc.gov

How do we know about sCJD and that they didn't have an exposure somewhere and thus being vCJD? There's so many exposures over 42 years that it would be impossible to isolate. Cattle, soil, sewage, etc since prions are so difficult to kill.

Yeesh that CDC report is scary. The person had an exposure as a kid??

 

[clozareal]

It has up to a 42 year incubation period..... you could already have it. There was a confirmed US outbreak of 26 cases in 2018.

Now I have illness anxiety...

 

[calvnandhobbs68]

How do we know about sCJD and that they didn't have an exposure somewhere and thus being vCJD? There's so many exposures over 42 years that it would be impossible to isolate. Cattle, soil, sewage, etc since prions are so difficult to kill.

Yeesh that CDC report is scary. The person had an exposure as a kid??

Classic CJD versus Variant CJD | Variant Creutzfeldt-Jakob Disease, Classic (CJD) | Prion Disease | CDC

www.cdc.gov

Now I have illness anxiety...

Let the fact that you have a 60X or higher risk of being diagnosed with high stage pancreatic cancer at some point in your life than any form of CJD reassure you.

 

[PsyDr]

I mean this whole thing is a little dramatic. Are you sure you mean vCJD vs sCJD?

1) Of course it's dramatic. This post isn't, "What psychiatric illness has the most mundane outcome?".

2) For which part? The outbreak? The incubation period? You're probably gonna win this one. You're the physician.