Akinetic mutism with recovery after repeated carbon monoxide poisoning

A 27-year-old man developed signs of personality change after exposure to carbon monoxide. One month later a second exposure was followed by an akinetic mute state with unusual motor seizures, probably associated with tentorial herniation and brain-stem compression. Elimination of carbon monoxide was unduly prolonged after the second exposure. The patient showed clinical evidence of dementia, but there has been a gradual improvement in cognitive and social functioning over two years.

Crisis theory and possibilities of therapeutic intervention

Too few psychiatrists in Britain have received an adequate training in psychotherapy, and the teaching of human personality growth and development is often woefully inadequate at both undergratuate and postgraduate levels—a state of affairs sometimes justified on the basis that existing knowledge has not been scientifically validated. For some psychiatrists their only training in communication with their patients is in clinical interviewing and their only understanding of their patients emotional life is derived from a study of gross psychopathology.

Acute carbon monoxide poisoning--3 years experience in a defined population

Between 1 January 1965 and 31 December 1967, 206 episodes of carbon monoxide poisoning were known to the coroner or the city hospitals in Newcastle upon Tyne.

The mortality rates were: suicidal exposure 38·2%; accidental exposure 39·7%.

In 21·3% of suicidal and 18·9% of accidental exposures recovery was complicated by prolonged delirium suggesting that all degrees of functional or structural neurological damage may have occurred, yet oxygen therapy was given in only 43·8% of suicidal and 34·5% of accidental exposures.

In view of the risk of persistent neuropsychiatric sequelae it is suggested that current patterns of management should be revised.