VIEWS: 47 PAGES: 31 POSTED ON: 3/16/2011
Psychological Issues in Diving From Alert Diver in 1999 and 2000. ---Psychological Issues in Diving Depressive Disorders, Drugs and References ---Psychological Issues in Diving II — Anxiety, Phobias in Diving --- Psychological Issues in Diving III - Schizophrenia, Substance Abuse These articles can be found on DAN’s web site at http://www.diversalertnetwork.org/medical/articles/i ndex.asp Ernest S Campbell, MD, FACS Ono Island, AL Mental Problems & Diving One should not dive if: Successful divers profile out of touch with reality; positively correlated to deeply depressed/suicidal; intelligence; paranoid with delusions characterized by a level of and hallucinations. neuroticism that is average taking drugs that might be or below average; dangerous at depth. score well on studies of However, there are many self-sufficiency and who dive with everyday anxieties, fears and emotional stability. neuroses. Hazards of Medications Drugs in combinations can Side Effects may include: be dangerous Seizure level 0.02% Few scientific studies Sedation, drowsiness, The condition is more dizziness, blurred vision, important than the drug. hypotension, tremor Drugs dangerous to Heart irregularities drivers are also dangerous Reduced exercise for divers. capability The interaction between Autonomic nervous the physiological effects system interference of diving and the Bruising pharmacological effects of medications is usually an Bronchial spasm (beta educated supposition. blockers) Psychotropic Drugs ANTIDEPRESSANTS: Hypnotics Tricyclics BENZODIAZEPINES SSRIs ANTIHISTAMINES MAOIs OMEGA-1 Others RECEPTOR AGONISTS MOOD STABILIZERS: OTHER Anticonvulsants Anxiolytics Antipsychotics BENZODIAZEPINES TYPICAL OTHERS ATYPICAL Depressive Illnesses Types Symptoms of mania Causes High mood, optimism Symptoms of Depression Delusions of grandeur Sadness, crying, guilt Irritability, aggression, Irritability, anger, anxiety Increased physical and Pessimism, indifference mental activity Loss of energy; aches Rapid speech, ideas Inability to concentrate Poor judgment, easily Social withdrawal distracted Reckless behavior Changed appetite, sleep Hallucinations, religiosity Recurring thoughts of death or suicide Antidepressives, Tricyclic Tricyclic Agents http://www.pharmacypracticenews.com/wworks/CHARTS/psycho/tex t/anti/tricyc/tricyc2.html All TCAs cause slowed cardiac conduction; all TCAs may lower seizure threshold; all cause sedation and orthostatic hypotension except protryptyline. Cardiac dysrhythmias. Non-lethal dysrhythmias can become lethal in the diving environment. AMITRIPTYLINE CLOMIPRAMINE DESIPRAMINE DOXEPIN IMIPRAMINE NORTRIPTYLINE PROTRIPTYLINE TRIMIPRAMINE (Surmontil, Wyeth-Ayerst) Antidepressives, SSRIs http://www.pharmacypracticenews.com/wworks/CH ARTS/psycho/text/anti/ssris/ssris2.html SSRI Drugs (Selective Serotonin Reuptake Inhibitors) Most may dive (Parker) CITALOPRAM (Celexa, Forest) FLUOXETINE (Prozac, Sarafem, Eli Lilly) FLUVOXAMINE (Luvox, Solvay) PAROXETINE (Paxil, GlaxoSmithKline) SERTRALINE (Zoloft, Pfizer) All can cause sedation and increased seizure activity. Antidepressives, MAOIs MAOIs (Monoamine oxidase inhibitor) http://www.pharmacypracticenews.com/wworks/CH ARTS/psycho/text/anti/maois/maois2.html ISOCARBOXAZID (Marplan, Oxford Pharm Services) PHENELZINE (Nardil, Pfizer) TRANYLCYPROMINE (Parnate, GlaxoSmithKline) Sedation, orthostatic hypotension, anticholinergic effects. Don’t take with SSRIs. ANTIDEPRESSANTS:OTHERS Other Drugs http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/anti/others/others2.html AMOXAPINE BUPROPION (Wellbutrin, GlaxoSmithKline) MAPROTILINE MIRTAZAPINE (Remeron, Organon) NEFAZODONE (Serzone, Bristol-Myers Squibb) TRAZODONE VENLAFAXINE (Effexor, Wyeth-Ayerst) MOOD STABILIZERS http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/anti/moodstab/moodsta3.html LITHIUM CARBONATE (slurred speech, confusion) CARBAMAZEPINE (dizziness, sedation, headache) VALPROIC ACID (Sedation, tremor) Alternative agents include gabapentin (Neurontin, Pfizer), lamotrigine (Lamictal, GlaxoSmithKline) and topiramate (Topamax, Ortho McNeil) Advice About Diving: Depression Individualize according to: The depressed person should • Drugs required not dive: • Response to treatment if there is any possibility • Time free of symptoms. of seizures. Consider: if there is difficulty in concentrating or following • decision making ability instructions. • responsibility to other if suicidal or has mental divers problems that would deter • relationship to drug interaction. induced side effects. Consider additive sedative Most texts advise no diving effect of nitrogen narcosis Anxiety, Panic & Phobias Anxiety is normal. Panic occurring at depth An inadvertent mishap can lead to => rapid =>over reactive anxiety ascent=>near-drowning state => irrational and/or DCI. behavior and lack of A phobia is an intense fear concern for the safety of of particular situations or others. things that are not Symptoms are “fight or normally dangerous. flight” (Adrenalin) Claustrophobia, may Sudden unexpected surges prevent immersion or even of anxiety are called entry into a recompression panic, and require quick chamber relief of the situation. Agoraphobia - "blue orb or dome syndrome” Panic Disorders 50% + divers experience “Trait anxiety" is a stable one or more panic/near or enduring feature of panic episodes (Morgan) personality, whereas “state Panic response: anxiety” is situational or o Irrational behavior. transitory. (Morgan) o Attention narrows A diver with trait anxiety is more likely to have o Cannot sort out options. increased state anxiety and Panic producing activities panic during scuba o malfunctioning equipment activities. o dangerous marine life Morgan WP Anxiety and o Disorientation during a panic in recreational scuba cave, ice or wreck dive divers. Sports Med 20 (6): 398-421 (Dec 1995) . Anxiolytics BENZODIAZEPINES http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/anxi/benzo/benzo2 .html ALPRAZOLAM CHLORDIAZEPOXIDE CLONAZEPAM CLORAZEPATE DIAZEPAM LORAZEPAM OXAZEPAM Used for anxiety disorders; panic disorder, alcohol withdrawal, seizure disorder, muscle spasm and pre op sedation. ANXIOLYTICS, OTHERS Drugs other than benzodiazepines http://www.pharmacypracticenews.com/ww orks/CHARTS/psycho/text/anxi/others/othe r2 .html BUSPIRONE (BuSpar, Bristol-Myers Squibb) HYDROXYZINE Hypnotics BENZODIAZEPINES http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/hypno/benzo/benzo3 .html ESTAZOLAM (ProSom, Abbott) FLURAZEPAM QUAZEPAM (Doral, Wallace) TEMAZEPAM TRIAZOLAM Hypnotics Antihistamines http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/hypno/hist/hist3 .html DIPHENHYDRAMINE DOXYLAMINE (Unisom, Pfizer) Avoid alcohol and other CNS depressants with these agents (except buspirone); drowsiness may impair ability to drive; use caution. Hypnotics OMEGA-1 RECEPTOR AGONISTS http://www.pharmacypracticenews.com/wworks/C HARTS/psycho/text/hypno/omega/omega3 .html ZALEPLON (Sonata, Wyeth-Ayerst) ZOLPIDEM (Ambien, Pharmacia) Avoid alcohol and other CNS depressants with these agents (except buspirone); drowsiness may impair ability to drive; use caution Diving Advice: Anxiety, Phobias & Panic Diving should be decided on the merits of each case, the type of drugs required, the response to medication, the length of time free of anxiety and phobic problems, decision making ability and responsibility to other divers. Divers with high trait anxiety are more likely to have increased state anxiety and panic during scuba activities. Severely affected probably should not dive but if allowed to dive should be carefully monitored and fully informed of their risks. Most texts advise no diving. Narcolepsy Narcolepsy is a chronic Driving restrictions for hereditary disorder of the narcolepsy usually entail a sleep regulatory brain narcolepsy-free period of one center - affecting 1:2000 people. year after starting treatment; Narcoleptics can fall and, no drug-related asleep or lose muscle tone symptoms. suddenly for periods from Treatment includes 30 seconds to more than stimulants, anti-cataleptic 30 minutes, have vivid dreamlike images when compounds and hypnotic drifting off to sleep and compounds. wake up unable to move or talk for a period of Diving Advice:Narcolepsy Whether or not a person with narcolepsy should be certified as 'fit to dive' should be decided on the merits of each case, the type of drugs required, the response to medication, and the length of time free of narcoleptic problems. Relationship to excitement, emotions and stressful situations should be taken into consideration. These persons probably should not dive except in highly controlled situations and possibly with a full face mask. Schizophrenia Schizophrenia is a serious Positive symptoms mental illness that affects one person in a hundred. Negative and Develops in youth, though disorganized it can start later in life. symptoms It is treatable, relapses are common, and it may never Causes clear up entirely. Medications (block Thoughts, feelings and chemical messengers, actions are somewhat such as dopamine) disconnected. Antipsychotics, Typical Typical (Dopamine receptor antagonists) http://www.pharmacypracticenews.com/wworks/CHARTS/psycho /text/psych/typical/typ2.html CHLORPROMAZINE MESORIDAZINE (Serentil, Boehringer Ingelheim) THIORIDAZINE FLUPHENAZINE PERPHENAZINE TRIFLUOPERAZINE HALOPERIDOL LOXAPINE (Loxitane, Watson) MOLINDONE (Moban, Endo) THIOTHIXENE High incidence of extrapyramidal effects, sedation ANTIPSYCHOTICS:ATYPICAL Atypical (Dopamine and serotonin receptor antagonists) http://www.pharmacypracticenews.com/wwork s/CHARTS/psycho/text/psych/atypical/atyp2.ht ml CLOZAPINE QUETIAPINE (Seroquel, AstraZeneca) OLANZAPINE (Zyprexa, Zydis, Eli Lilly) RISPERIDONE ( Risperdal, Janssen) Advice About Diving: Schizophrenics Decision-making ability, responsibility to other divers and relationship to drug induced side effects that would limit ability to gear up and move in the water should be taken into consideration. Most probably should not consider diving. Those responsible for divers should be alert to those with inappropriate responses or activity, paranoid behavior or unusual ideation and be quick to ask and find out more about the possibility of schizophrenia. Most texts advise no diving. Marijuana Effects on Divers General effects of Withdrawal symptoms : smoking marijuana: Restlessness, · Tolerance and insomnia, nausea, reducing effect with irritability, loss of use. appetite, sweating. · Psychological and mild Risk of adverse physical dependence reactions is greater for with regular use. persons who have had The cannabinoid effect psychotic disorder, may be additive to Tar content of nitrogen narcosis. marijuana is greater Carbon monoxide leads than cigarettes, with to hypoxia on ascent. more carcinogens. Marijuana Effects on Divers Harmful effects: Chronic use may cause: Distorted perception. Bronchitis, Sinusitis, Impaired recent Pharyngitis, Chronic memory, confusion, cough, Emphysema, Loss of muscle strength Lung cancer. and balance. Poor immune system Decreased blood flow in functioning; brain, lower exercise Poor motivation, tolerance, rapid HR depressed mental Impaired motor skills functioning. Depression, panic May predispose to DC. (50%) Effects may be potentiated by depth Alcohol and Diving Alcohol causes: Decreased behavioral Diuresis and components required dehydration, for safe diving when Diminished awareness alcohol has been on of cues and reduced board in past 24 inhibitions. (Perrine, hours: Mundt and Weiner) Reaction time Blood Alcohol Visual tracking Concentration (BAC) Concentrated 180# man, two attention beers/1 hour = 0.04% Processing data in Reduction in divided attention information tasks processing, Effects of Alcohol, Egstrom Review of 150 studies Ingestion of small Alcohol effects are amounts of alcohol mood elevation, slight degrades dizziness and some performance. impairment of Variables alter effects judgment, self control, of alcohol, but they do inhibitions and not overcome the memory. CNS changes. Increases in reaction Alcohol can be time and decreases in cleared from the coordination follow blood at a predictable the dose/response rate of .015% BAC curve quite well. per hour. Multitasking is One drink can affected by alcohol to Links and References, Alcohol & Diving ‘Alcohol and Aquatic N2 narcosis and Performance’ by Glen alcohol –a scuba Egstrom, Ph.D fatality. J Forensic Alcohol use and Sci.1987Jul;32(4):1095 aquatic activities-- Effects of ethanol and Massachusetts. amphetamine on IGN (1990). JAMA - in humans. Undersea (Chicago), 264(1), 19- Biomed Res. 1986 20. Sep;13(3):345-54. Alcohol potentiates Ethanol and nitrogen the effects of inert may share the same gas narcosis. Aviat mechanisms of action Space Environ Med in the brain Alcohol. 1993 Jun; 64(6):493-9 1996 Jan Feb;13(1):75- Attention Deficit Disorder (ADHD, ADD) ADHD or ADD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity. Treatment – various forms of methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). Nitrox diving contraindicated due to risk of seizures. Advice re diving: Case by case review in treatment responders. Diving with ADD would seem to be somewhat risky, considering the attention to multiple tasking that is required in diving.
Pages to are hidden for
"Psychological Issues in Diving"Please download to view full document