The influenza virus itself was not selective in its victims, belying notions of gender, class, and racial superiority. . . . Anyone might become ill, anyone might provide comfort. Nancy K Bristow1
Infectious outbreaks have shaped the psyche of humanity for times immemorial. Epidemics and pandemics propagate fear and erratic behavior and, long after they are over, remain entrenched within the global psyche, often in the form of folk tale and literary or historical accounts. Naturally, logically, and unsurprisingly, the larger the scale of an outbreak, the larger the impact and magnitude of its sequelae. The black plague pandemic, starting in 1345, claimed up to 100 million lives and is still the topic of lively speculation and research to this day; the influenza pandemic of 1918 still receives attention. The Table summarizes major historical outbreaks, with estimated lives affected.
In recent years, media attention has shaped outbreak coverage in various ways, heightening alarm while serving as a useful tool for encouraging precautions and prevention. However, pandemic spread of infectious diseases has also been a cause of concern because of increased air travel and an overall increase in global connectedness. Smaller outbreaks receive much media coverage as infectious diseases thought to be eradicated resurface, but also in highlight of crowded or unsanitary conditions. Outbreaks of mumps, measles, and polio have been noted in various communities (such as jails, detention centers, daycare centers). Large numbers of refugees, victims of global strife, often have limited access to medical care, and have been found to lack required levels of sero-prevalence needed for herd immunity for vaccine-preventable infections.2
Outbreak, epidemic, and pandemic are all terms that are coming back into the human lexicon after decades of complacency about the protections of modern medicine. An “outbreak” is a sudden increase in a condition, or disease cluster—infectious or otherwise. An “epidemic” is defined as a widespread occurrence of an infectious or non-infectious disease in a community at a particular time; whereas a “pandemic” is an epidemic that crosses country and continent boundaries.
The effect of outbreaks on mental illness can be loosely conceptualized as:
• Potentially affecting existing illnesses;
• Precipitating new-onset mental symptoms in children or adults, possibly related to the interplay of immunity and mental illness; and
• Causing distress in the caretakers of affected individuals (Figure).
Alternatively, the psychiatrist can consider the effects in terms of acute versus chronic issues.
Dr Moukaddam is Associate Professor, Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Ben Taub Adult Outpatient Services Director, Medical Director, STAR (Stabilization, Treatment, and Rehabilitation) Program for Psychosis, Houston, TX. She reports no conflicts of interest concerning the subject matter of this article.
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