Psychological sequelae of mountain accidents: a preliminary study

Acute Mountain Sickness and the Risk of Subsequent Psychiatric Disorders-A Nationwide Cohort Study in Taiwan

We aim to explore if there is a relationship between acute mountain sickness (AMS) and the risk of psychiatric disorders in Taiwan by using the National Health Insurance Research Database for to the rare studies on this topic. We enrolled 127 patients with AMS, and 1270 controls matched for sex, age, monthly insured premiums, comorbidities, seasons for medical help, residences, urbanization level, levels of care, and index dates were chosen from 1 January 2000 to 31 December 2015. There were 49 patients with AMS and 140 controls developed psychiatric disorders within the 16-year follow-up. The Fine-Gray model analyzed that the patients with AMS were prone to have a greater risk for the development of psychiatric disorders with an adjusted sub-distribution hazard ratio (sHRs) of 10.384 (95% confidence interval [CI]: 7.267-14.838, p < 0.001) for psychiatric disorders. The AMS group was associated with anxiety disorders, depressive disorders, bipolar disorder, sleep disorders, posttraumatic stress disorder/acute stress disorder, psychotic disorder, and substance-related disorder (SRD). The relationship between anxiety, depression, sleep disorders, SRD, and AMS still persisted even after we excluded the psychiatric disorders within the first five years after AMS. There was an association between AMS and the rising risk of psychiatric disorders in the 16 years of long-term follow-up research.

Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association

OBJECTIVE

The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS).

METHODS

Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS).

RESULTS

Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms.

CONCLUSION

The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.

Going to Altitude with a Preexisting Psychiatric Condition

Psychiatric disorders have a high lifetime prevalence affecting about 30% of the global population. Not much is known about high altitude (HA) sojourns in individuals living with a psychiatric condition. This lack of scientific evidence contrasts with the anticipated increase in numbers of individuals with preexisting psychiatric conditions seeking medical advice on HA exposure. Not only are there risks associated with a HA climb, but physical activity in general is known to improve symptoms of many psychiatric disorder and enhance measures of mental well-being like quality of life and resilience. There are additional positive effects of alpine environments on mental health beyond those of physical activity. All individuals going to HA with a preexisting psychiatric condition should be in a state of stable disease with no recent change in medication. Specific considerations and recommendations apply to individual psychiatric disorders. During the HA sojourn the challenge is to separate altitude-related symptoms such as insomnia from prodromal symptoms of the underlying disorder (e.g., depressive episode) or altitude-related hyperventilation from panic attacks. In case an individual with preexisting anxiety disorder decides to go to HA there might be a predisposition toward acute mountain sickness (AMS), but it should always be considered that many symptoms of anxiety and AMS overlap. Any medication that is anticipated to be taken during ascent or at HA should be tested for compatibility with the psychiatric condition and medication before the trip.

The frequency of post-traumatic stress disorder symptoms in athletes with and without sports related concussion

Background

Purpose of this study is to investigate the presence and frequency of post-traumatic stress disorder (PTSD) symptoms in post-concussed (PC) athletes compared to a group of healthy control (HC) athletes.

Research design and method

A pre and post-test group design was used to compare a post-concussed group to a matched healthy control group of athletes. An archival database which included PC (n = 62) and HC (n = 62) participants matched on age, years of education and gender who completed a test battery at baseline and post injury, The test battery was comprised of a neurocognitive assessment, self-reported symptom inventory and PTSD symptom questionnaire. Post-concussion assessment was obtained within 0–13 days post-injury.

Results

PTSD symptom scores were greater in PC post injury group (Mdn = 0) than for the HC group (Mdn = 0.0), U = 1282.0, p = 0.000, r = 0.34. A Wilcoxon Signed-ranks test indicated that PTSD symptom scores post-injury (Mdn = 0) were significantly higher than pre-injury (Mdn = 0), Z = − 2.75, p = 0.000, r = 0.35. Within the PC post injury group athletes having “difficulty sleeping” was the highest reported symptom an average of 25.8% followed by “avoiding similar situations” at an average of 19.4%. “Having trouble keeping thoughts of incident out of your head” was reported at an average of 17.7% and “flashbacks” were reported at an average of 12.9%. “Nightmares” and “feeling numb and detached” were reported at an average of 8.1 and 6.5% respectively.

Conclusion

Athletes who reported no PTSD symptoms prior to sports related concussion do exhibit symptoms of PTSD. Providing a PTSD symptom questionnaire may provide a more comprehensive treatment plan for PC post injury athletes who may be at risk of chronic PTSD symptoms.

Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue: Evidence-based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol. 19:131–140, 2018.

Introduction: Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas.

Materials and Methods: Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue.

Results: We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents.

Discussion: General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings.

Conclusions: Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

The psychological impact of accidents on recreational divers: a prospective study

OBJECTIVE

The present study aimed to examine the medium and long term psychological impact of diving accidents on the victims (n=52), compared with the impact on two control groups: the victim's diving "buddy" (n=40) who simply witnessed the accident, and a second control from the same boat who did not dive with the victim (n=38).

METHODS

This was a prospective cohort study of the impact of an accident on the victims who attended the Hyperbaric Unit, in comparison with the two control groups. Pre-accident psychological morbidity was assessed using the General Health Questionnaire. Trauma symptoms were assessed using the Revised Impact of Events Scale at 3, 6 and 12 months post accident.

RESULTS

The accident victims endorsed more trauma symptoms and experienced them more intensely and for longer, compared with the two control groups.

CONCLUSION

A significant minority of diving accident victims (between 25% and 50%) continued to suffer from the psychological impact of the accident, some for over a year. This has important implications for their future health care, for their safety on subsequent dives, and for dive training.

Trial of interpersonal counselling after major physical trauma

OBJECTIVE

The purpose of the present study was to determine if interpersonal counselling (IPC) was effective in reducing psychological morbidity after major physical trauma.

METHODS

One hundred and seventeen subjects were recruited from two major trauma centres and randomized to treatment as usual or IPC in the first 3 months following trauma. Measures of depressive, anxiety and post-traumatic symptoms were taken at baseline, 3 months and 6 months. The Structured Clinical Interview for DSM IV diagnoses was conducted at baseline and at 6 months to assess for psychiatric disorder.

RESULTS

Fifty-eight patients completed the study. Only half the patients randomized to IPC completed the therapy. At 6 months the level of depressive, anxiety and post-traumatic symptoms and the prevalence of psychiatric disorder did not differ significantly between the intervention and treatment-as-usual groups. Subjects with a past history of major depression who received IPC had significantly higher levels of depressive symptoms at 6 months.

CONCLUSION

IPC was not effective as a universal intervention to reduce psychiatric morbidity after major physical trauma and may increase morbidity in vulnerable individuals. Patient dropout is likely to be a major problem in universal multi-session preventative interventions.

Psychophysiological Response to Severe Sport Injury Among Competitive Male Athletes: A Preliminary Investigation

Features of posttraumatic distress have been associated with treatment noncompliance and delayed surgical recovery among general medical and trauma populations. Although cognitive-affective and behavioral features of posttraumatic distress have been demonstrated among adult and adolescent athletes with injuries, physiological responses associated with posttraumatic distress have not yet been examined in this population. The objective of this study was to examine psychophysiological stress reactivity to orthopedic trauma among male athletes who sustained a severe sport injury. Athletes with injuries (n= 7) and non-injured athlete controls (n= 5) completed self-report measures of psychological distress and were then shown injury video footage while heart rate and skin conductance measures were recorded. After exposure to orthopedic trauma-related video footage, athletes with injuries demonstrated significantly greater skin conductance reactivity and subjective distress compared to controls. As demonstrated among other medical and trauma populations, athletes with injuries exhibit exaggerated stress reactivity profiles when primed with orthopedic trauma stimuli.

Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides

OBJECTIVE

The present study was designed to assess the frequency of trauma exposure, the prevalence rates of posttraumatic stress disorder, comorbid symptoms, and sense of coherence (SOC) in Swiss mountain guides.

METHOD

All mountain guides (n=1347) were surveyed using of the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire (GHQ-28), and the Sense of Coherence Self-Rating Scale (SOC-29).

RESULTS

Although Swiss mountain guides are exposed to many traumatic situations, the prevalence rate of PTSD is very low (2.7%), and their SOC total scores are high (157.9+/-18.4). Subgroups differentiated by the extent of traumatic stress symptoms differ significantly in SOC and GHQ total scores. Regression analysis showed SOC total score to be a significant predictor, although it only accounted for 1% of the variance in the number of PTSD symptoms endorsed.

CONCLUSION

The low prevalence rate of PTSD is not in line with findings in other high-risk populations for PTSD. SOC seems to be a marker for psychological health rather than a protective factor against PTSD.

Individual characteristics in occupational accidents due to imbalance: a case-control study of the employees of a railway company

BACKGROUND

Falls are frequent occupational accidents, and are responsible for a significant amount of lost working time and, more importantly, for a high mortality. The factors involved in falling mechanisms can be of external or individual origin, the latter being less well identified.

AIMS

To assess the relations between certain individual characteristics and occupational accidents due to imbalance.

METHODS

A total of 427 male employees, who had been victims of at least one occupational accident with sick leave due to imbalance (cases) and 427 controls were recruited among the employees of a large French railway company. A standardised questionnaire on life conditions and professional factors, and a description of the accidents was filled in by an occupational physician for each subject.

RESULTS

Some job categories were more affected by a specific release mechanism of work related falls. Certain individual characteristics such as smoking, alcohol consumption, inactivity, sleep disorders, and request for a job change were correlated with the occurrence of occupational accidents. Sick leaves of eight days or over were more frequent in older and overweight injured workers. Some lesions were linked with the specific fall released mechanisms.

CONCLUSIONS

Individual characteristics can increase the risk of occupational accidents, especially falling. This study identified subjects most at risk on whom prevention related to working conditions and falls could be focused.

Functional neuroimaging correlates of functional amnesia

Especially in the field of memory encoding and retrieval, the results of functional neuroimaging have provided new insights in anatomico-functional interactions. In particular this holds true for the role of the prefrontal cortex in mnestic information processing, for the contribution and participation of the two hemispheres in various processes of information transmission, and for views on disturbed information processing after organically obvious and so-called psychogenic forms of memory impairments. This report particularly stresses the insights obtained by functional neuroimaging for probably environmentally triggered deficiencies in memory processing and discusses possible subtle neuroanatomical correlates of functional amnesias. It is especially emphasised that stress conditions and depressive states may modify the release of steroids (glucocorticoids) and transmitter agonists at the brain level with the consequence of selective memory disturbances which may manifest as a "mnestic block syndrome".