scholarly journals Isolated psychosis during exposure to very high and extreme altitude – characterisation of a new medical entity

2017 ◽  
Vol 48 (11) ◽  
pp. 1872-1879 ◽  
Author(s):  
Katharina Hüfner ◽  
Hermann Brugger ◽  
Eva Kuster ◽  
Franziska Dünsser ◽  
Agnieszka E. Stawinoga ◽  
...  
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Supplemental Oxygen ◽  
Status Change ◽  
Statistical Manual ◽  
Medical Diagnoses ◽  
Diagnostic And Statistical Manual ◽  
Extreme Altitude ◽  
Medical Entity ◽  
Very High

BackgroundPsychotic episodes during exposure to very high or extreme altitude have been frequently reported in mountain literature, but not systematically analysed and acknowledged as a distinct clinical entity.MethodsEpisodes reported above 3500 m altitude with possible psychosis were collected from the lay literature and provide the basis for this observational study. Dimensional criteria of the Diagnostic and Statistical Manual of Mental Disorders were used for psychosis, and the Lake Louise Scoring criteria for acute mountain sickness and high-altitude cerebral oedema (HACE). Eighty-three of the episodes collected underwent a cluster analysis to identify similar groups. Ratings were done by two independent, trained researchers (κ values 0.6–1).FindingsCluster 1 included 51% (42/83) episodes without psychosis; cluster 2 22% (18/83) cases with psychosis, plus symptoms of HACE or mental status change from other origins; and cluster 3 28% (23/83) episodes with isolated psychosis. Possible risk factors of psychosis and associated somatic symptoms were analysed between the three clusters and revealed differences regarding the factors ‘starvation’ (χ2 test, p = 0.002), ‘frostbite’ (p = 0.024) and ‘supplemental oxygen’ (p = 0.046). Episodes with psychosis were reversible but associated with near accidents and accidents (p = 0.007, odds ratio 4.44).ConclusionsEpisodes of psychosis during exposure to high altitude are frequently reported, but have not been specifically examined or assigned to medical diagnoses. In addition to the risk of suffering from somatic mountain illnesses, climbers and workers at high altitude should be aware of the potential occurrence of psychotic episodes, the associated risks and respective coping strategies.

scholarly journals Deciphering Molecular Cascades in a Novel Acclimatization Strategy for Rapid Ascent to High Altitude

2017 ◽  
Author(s):  
Subhojit Paul ◽  
Anamika Gangwar ◽  
Kalpana Bhargava ◽  
Yasmin Ahmad
Keyword(s):  
High Altitude ◽  
Plasma Proteins ◽  
Redox Homeostasis ◽  
Redox Stress ◽  
Rapid Induction ◽  
Extreme Altitude ◽  
Two Factors ◽  
Rapid Ascent ◽  
Very High ◽  
Bioinformatics Workflow

ABSTRACTThe repercussions of hypobaric hypoxia are dependent upon two factors-time and intensity of exposure. The effects of intensity i.e. variation of altitude are yet unknown although it is a significant factor in terms of acclimatization protocols. In this study we present the effects of acute (24 h) exposure to high (10,000 ft), very high (15,000 ft) and extreme altitude (25,000 ft) zones on lung and plasma using semi-quantitative redox specific transcripts and quantitative proteo-bioinformatics workflow in conjunction with redox stress assays. Our findings indicate that very high altitude exposure elicits systemic redox homeostatic processes due to failure of lung redox homeostasis without causing mortality. We also document a rapid acclimatization protocol causing a shift from 0 to 100% survival at 25,000 ft in male SD rats upon rapid induction. Finally we posit the various processes involved and the plasma proteins that can be used to ascertain the acclimatization status of an individual.

Pathophysiology and management of altitude-related disorders

2016 ◽  
Author(s):  
Daniel S. Martin ◽  
Michael P. W. Grocott
Keyword(s):  
High Altitude ◽  
Acute Mountain Sickness ◽  
Specific Treatment ◽  
Symptomatic Treatment ◽  
Supplemental Oxygen ◽  
Poor Sleep ◽  
Effective Prophylaxis ◽  
Life Threatening ◽  
Medical Emergencies ◽  
Limiting Condition

Acute high-altitude related illnesses include acute mountain sickness (AMS), high altitude pulmonary oedema (HAPO) and high altitude cerebral oedema (HACO). AMS is characterized by headache, lack of appetite, poor sleep, lethargy, and fatigue. AMS is a common, generally benign, self-limiting condition if managed with rest, no ascent, and symptomatic treatment. Descent is indicated in severe cases. HACO and HAPO are rare, but serious conditions that should be considered life-threatening medical emergencies. HACO is characterized by the presence of neurological signs (including confusion) at altitude, commonly in the presence of headache. HAPO is characterized by breathlessness and signs of respiratory distress at altitude, particularly accompanying exercise. Management of HACO and HAPO involves urgent descent, supplemental oxygen (cylinder, concentrator, or portable hyperbaric chamber) if available, and specific treatment with dexamethasone (HACO) or nifedipine (HAPO). Slow controlled ascent (adequate acclimatization) is the best prophylaxis against the acute high-altitude-related illnesses. Acetazolamide is an effective prophylaxis against AMS.

scholarly journals MEDEX 2015: Prophylactic Effects of Positive Expiratory Pressure in Trekkers at Very High Altitude

2021 ◽  
Vol 12 ◽  
Author(s):  
Thomas Rupp ◽  
Claire Maufrais ◽  
Guillaume Walther ◽  
François Esteve ◽  
Jamie Hugo Macdonald ◽  
...  
Keyword(s):  
Cardiac Output ◽  
High Altitude ◽  
Sea Level ◽  
Near Infrared ◽  
Acute Mountain Sickness ◽  
Hypoxic Exposure ◽  
2D Echocardiography ◽  
Mountain Sickness ◽  
Very High ◽  
Positive Expiratory Pressure

Purpose: Positive expiratory pressure (PEP) breathing has been shown to increase arterial oxygenation during acute hypoxic exposure but the underlying mechanisms and consequences on symptoms during prolonged high-altitude exposure remain to be elucidated.Methods: Twenty-four males (41 ± 16 years) were investigated, at sea level and at 5,085 m after 18 days of trekking from 570 m. Participants breathed through a face-mask with PEP = 0 cmH2O (PEP0, 0–45th min) and with PEP = 10 cmH2O (PEP10, 46–90th min). Arterial (SpO2), quadriceps and prefrontal (near infrared spectroscopy) oxygenation was measured continuously. Middle cerebral artery blood velocity (MCAv, transcranial Doppler), cardiac function (2D-echocardiography), extravascular lung water accumulation (UsLC, thoracic ultrasound lung comets) and acute mountain sickness (Lake Louise score, LLS) were assessed during PEP0 and PEP10.Results: At 5,085 m with PEP0, SpO2 was 78 ± 4%, UsLC was 8 ± 5 (a.u.) and the LLS was 2.3 ± 1.7 (all P < 0.05 versus sea level). At 5,085 m, PEP10 increased significantly SpO2 (+9 ± 5%), quadriceps (+2 ± 2%) and prefrontal cortex (+2 ± 2%) oxygenation (P < 0.05), and decreased significantly MCAv (−16 ± 14 cm.s–1) and cardiac output (−0.7 ± 1.2 L.min–1) together with a reduced stroke volume (−9 ± 15 mL, all P < 0.05) and no systemic hypotension. PEP10 decreased slightly the number of UsLC (−1.4 ± 2.7, P = 0.04) while the incidence of acute mountain sickness (LLS ≥ 3) fell from 42% with PEP0 to 25% after PEP10 (P = 0.043).Conclusion: PEP10 breathing improved arterial and tissue oxygenation and symptoms of acute mountain sickness after trekking to very high altitude, despite reduced cerebral perfusion and cardiac output. Further studies are required to establish whether PEP-breathing prophylactic mechanisms also occur in participants with more severe acute mountain sickness.

scholarly journals The Biochemical Biomarkers Determination in Alzheimer Dementia

2018 ◽  
Vol 69 (11) ◽  
pp. 3155-3159 ◽  
Author(s):  
Victoria Birlutiu ◽  
Laura Stef ◽  
Sebastian Ioan Cernusca Mitariu ◽  
Corina Roman Filip ◽  
Lavinia Duica ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Stage ◽  
Multidisciplinary Care ◽  
Statistical Manual ◽  
Alzheimer Dementia ◽  
Diagnostic And Statistical Manual ◽  
Severe Stage ◽  
Detection Of Biomarkers ◽  
State Examination ◽  
Very High

Alzheimer�s disease (AD) is a complex neuropsychiatric condition characterized by progressive cognitive symptoms.The social and psychological costs associated with the care of AD patients are very high; therefore, significant funds for research in this field are being invested worldwide. The accuracy of medical methods for establishing the diagnosis of AD with specific neuropathology is very important. Biomarkers can detect AD in their pre-clinical stage, monitor the disease progression, and detectmore objectively the treatment response. We performed a retrospective study of 100 patients admitted to the Gheorghe Preda Psychiatric Hospital of Sibiu with the diagnosis of Mild Cognitive Impairment and Alzheimer�s Dementia. The diagnosis was established according to the Diagnostic and Statistical Manual Disorders-4th edition criteria and the severity of the condition was determined by the Mini Mental State Examination. Our retrospective study revealed that in a certain period of time, most hospitalized patients with AD had the most days of hospitalization; they were patients in severe stage, due to the needs of multidisciplinary care and the multiple possibilities offered by medical staff. At present, AD research, in addition to finding therapeutic remedies in the clinical stages of AD, also aims at primary and secondary prevention strategies, including the detection of biomarkers in the pre-clinical stage of AD.

Comparison of Alcohol Use Disorders in DSM and ICD

2020 ◽  
Vol 66 (3) ◽  
pp. 143-153
Author(s):  
Jessica W. M. Wong ◽  
Friedrich M. Wurst ◽  
Ulrich W. Preuss
Keyword(s):  
Alcohol Use Disorders ◽  
International Classification Of Diseases ◽  
Clinical Use ◽  
Diagnostic Systems ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Historical Developments

Abstract. Introduction: With advances in medicine, our understanding of diseases has deepened and diagnostic criteria have evolved. Currently, the most frequently used diagnostic systems are the ICD (International Classification of Diseases) and the DSM (Diagnostic and Statistical Manual of Mental Disorders) to diagnose alcohol-related disorders. Results: In this narrative review, we follow the historical developments in ICD and DSM with their corresponding milestones reflecting the scientific research and medical considerations of their time. The current diagnostic concepts of DSM-5 and ICD-11 and their development are presented. Lastly, we compare these two diagnostic systems and evaluate their practicability in clinical use.

Angststörungen – von der ICD-10 zur ICD-11

2020 ◽  
pp. 1-5
Author(s):  
Timo D. Vloet ◽  
Marcel Romanos
Keyword(s):  
Mental Disorders ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases ◽  
Icd 10

Zusammenfassung. Hintergrund: Nach 12 Jahren Entwicklung wird die 11. Version der International Classification of Diseases (ICD-11) von der Weltgesundheitsorganisation (WHO) im Januar 2022 in Kraft treten. Methodik: Im Rahmen eines selektiven Übersichtsartikels werden die Veränderungen im Hinblick auf die Klassifikation von Angststörungen von der ICD-10 zur ICD-11 zusammenfassend dargestellt. Ergebnis: Die diagnostischen Kriterien der generalisierten Angststörung, Agoraphobie und spezifischen Phobien werden angepasst. Die ICD-11 wird auf Basis einer Lebenszeitachse neu organisiert, sodass die kindesaltersspezifischen Kategorien der ICD-10 aufgelöst werden. Die Trennungsangststörung und der selektive Mutismus werden damit den „regulären“ Angststörungen zugeordnet und können zukünftig auch im Erwachsenenalter diagnostiziert werden. Neu ist ebenso, dass verschiedene Symptomdimensionen der Angst ohne kategoriale Diagnose verschlüsselt werden können. Diskussion: Die Veränderungen im Bereich der Angsterkrankungen umfassen verschiedene Aspekte und sind in der Gesamtschau nicht unerheblich. Positiv zu bewerten ist die Einführung einer Lebenszeitachse und Parallelisierung mit dem Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Schlussfolgerungen: Die entwicklungsbezogene Neuorganisation in der ICD-11 wird auch eine verstärkte längsschnittliche Betrachtung von Angststörungen in der Klinik sowie Forschung zur Folge haben. Damit rückt insbesondere die Präventionsforschung weiter in den Fokus.

Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults

2017 ◽  
Vol 33 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Anne van Alebeek ◽  
Paul T. van der Heijden ◽  
Christel Hessels ◽  
Melissa S.Y. Thong ◽  
Marcel van Aken
Keyword(s):  
Young Adults ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Adolescents And Young Adults ◽  
Patient Questionnaire ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Dsm Iv

Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.

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