More old news

The day – that is to say, Monday – started with an email from Medscape containing some important breaking news about how being a pain has been dignified with a fancy name – Intermittent Explosive Disorder (IED) – and an entry in DSM (DSM-5 312.34 (F63.81)) – thus, presumably, making it a chargeable item against medical insurance – for the 20% or so of sufferers who seek treatment. In which connection, Bing tells me that ‘F63.81 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes’.

All part of the never-ending quest to corral disease into a tidy structure of named entities. Some of which, including I think this one, are not very tidy in that there is an element of ‘not elsewhere specified’ about them. The last in the list. All the stuff which one failed to package up otherwise. A quest now made easier by allowing people to have more than one complaint at a time. A quest which is justified by the need to talk about disease, to share information about disease and hopefully to treat it.

To be fair, this one is more than just being a pain. Rather, the sort of person who, from time to time and in a quite unpredictable way, reacts in a quite disproportionately aggressive and violent fashion – usually verbally, sometimes physically – to some trivial slight or mischance. The sort of person it is wearing to be around. Perhaps not the person you chose for a relaxed game of golf, with that game’s wealth of missed shots being all too likely to trigger an outburst. The objects of this violence are usually people, but might also be things like golf clubs, personal computers, doors or walls. Apparently, there is quite a lot of this sort of thing about, affecting maybe 4% of us in the course of our lives and, what with one thing and another, it costs a great deal of money. There is also a lot of overlap with other mental disorders, for example substance abuse. A disease handily summarised at the new to me mental encyclopedia at reference 2; one of the many well-being-self-helps to be found out on the Internet. IED very properly filed under ‘I’.

What is not so fair is that this is not new news at all and lots of people having been working away at IED for twenty years or more. It takes quite a long time to work your way into a big classification like DSM! So Medscape, along with other news aggregators who pop-up in Microsoft’s Edge, do not scruple to rake up old stuff when they are short of new.

Along the way, I came across an unpleasant microorganism called Toxoplasma gondii, a parasite which prefers cats, but which can easily infect other mammals and which attracts a long entry in Wikipedia at reference 3. It seems that one of the things that it can do is lodge in the neurons of the brains of rodents, particularly mice and rats, disturbing things in such a way as to make them easier meat for cats. Furthermore, it is a successful and common microorganism which has infected more than a tenth of us, generally but not always without consequence. There was a suggestion that one of the consequences might be IED or some other mental disorder, but my quick excursion into the matter suggests that the evidence for that was rather mixed.

An excursion which included learning that taking blood from Māoris is complicated by the need for special treatment of anything left over from testing. They like care to be taken with stuff that used to be part of their bodies.

That apart, reference 5 is a study based on a sample of around 1,000 people born in the early 1970's in Dunedin in New Zealand. An important longitudinal study which has been running for a long time, described at reference 6, but which strikes me, nevertheless, as a fairly small sample for present purposes. Notwithstanding, it offers no support to the suggestion that this parasite is important in mental disorder.

PS 1: regarding the tenth, infection rates for Toxoplasma gondii vary a good deal across the US and across the world. In some places the rates are very high, say more than 50%.

PS 2: and while we are on bugs, later on in the day, I came across a piece in the NYRB (reference 7) about fungi, about how one new fungus has killed millions of hibernating bats and another which has killed a lot more amphibians, particularly frogs. One common thread here being a low body temperature, just right for fungi. So far, we humans have been protected to some large extent by our high body temperatures. But just coming along is something called Candida auris, which can kill older people with pre-existing conditions. See references 8 and 9.

PS 3: the odd-ball site from which I took the illustration to this post, reference 10, took the unusual step of verifying my computer before it let me see theirs. And telling me so. Not something I have seen before. Let’s hope they were not up to anything untoward.

PS 4: upping the font size on the heading that follows has made it a bit more prominent in its Windows 11 rendering. Seems like a good idea, so made the same change to a couple of other recent posts to see how it looked there. But no pleasing everyone without getting a good deal more geeky about it!

References

Reference 1: Why Explosive Anger Isn't Just a 'Bad Attitude,' but a Symptom – Joe Kita, Medscape – 2023.

Reference 2: https://www.theravive.com/therapedia/. 

Reference 3: https://en.wikipedia.org/wiki/Toxoplasma_gondii. 

Reference 4: Toxoplasma gondii infection in humans and animals in the United States – Dubey J P, Jones J L – 2008. Some statistics.

Reference 5: Is Toxoplasma Gondii Infection Related to Brain and Behavior Impairments in Humans: Evidence from a Population-Representative Birth Cohort – Karen Sugden, Terrie E. Moffitt, Lauriane Pinto, Richie Poulton, Benjamin S. Williams, Avshalom Caspi – 2016. 

Reference 6: The Dunedin Multidisciplinary Health and Development Study: overview of the first 40 years, with an eye to the future - Richie Poulton, Terrie E. Moffitt, Phil A. Silva – 2014.

Reference 7: Spored to death – Elizabeth Kolbert, NYRB – 2023.

Reference 8: https://en.wikipedia.org/wiki/Candida_auris. 

Reference 9: https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-issues-warning-multidrug-resistant-yeast-infection. 

Reference 10: https://debuglies.com/.