There is a report in a December 1996 issue of the British journal Lancet, alerting doctors to the fact that 10 of the young English victims of CREUTZFELDT-JAKOB DISEASE presented with symptoms mistaken as psychiatric.
CJ Disease, like ALS, is a relentless, presently incurable, deterioration of brain tissue. It is a subacute (weeks, months....) dementia leading to death.
In part the mistake was blamed on the absence of the reputedly pathognomonic periodic bitemporal spikes on their EEG's.
EEG findings may be absent in the early stages, but at autopsy there is always something to see: the gray matter of the temporal lobes and diencephalon especially, - parts of the anatomical substrate for memory and emotion - are preferentially damaged.
These are microscopic views of gray matter in CJ disease with the notorious "status spongiosus" - multiple small holes - according to one text up to 50 micromillimeters in diameter (not quite Swiss Cheese) - on the LEFT and hypertrophy of astrocytes on the RIGHT.
It has been established that CJ disease is caused by a transmissible agent and can cross species. There have been documented human cases associated with corneal transplants, depth electrodes, and administration of Growth Hormone derived from animal pituitaries.
The Growth Hormone story is cautionary. We should probably avoid products derived from animal brain.
For example, if one uses Melatonin (a remarkable soporific and dream-inducing hormone which declines radically with age), it would seem prudent to choose a synthetic product rather than "natural."
With regard to the recurring problem of "mistaking" organic diseases for psychiatric ones: the problem is very straightforward. When I evaluate a complicated neurologic patient, the first conclusion I wish to arrive at is whether there is neurologic disease (my impression or diagnosis) - or not.
It is hard enough to arrive at accurate diagnoses in neurology that it is just plain practical as well as logical to consider two categories:
- Disease
- No disease
Not three:
- Disease
- No disease
- Disease of the mind (Psychiatric or Mental Illness)
Diseases of the mind can't be seen, can't be touched, and can't be tested.They are metaphorical, like "heartbreak" is a metaphor. There are no cardiac tests for heartbreak.
Creutzfeldt-Jakob would not have be "mistaken for psychiatric " - nor would vitamin and endocrine deficiencies (e.g. B12, hypothyroidism), strokes (e.g. expressive dysphasias), Neuroleptic Malignant Syndrome (as "Catatonic Schizophrenia") - if more physicians were honest with themselves about the pseudo-science of psychiatry or if more were familiar with the works of Thomas S. Szasz.
Anyway, it looks like England's Mad Cow Disease may have originated with a bad batch of cow food in the late 1980's. Some cow food includes other cows the way Soylent green was people.
Questions? Comments?
Write me at DrJohn@idiom.com