Acute psychosis associated with diving.
There are only a few reported cases of psychiatric disorders presenting a s decompression sickness (DCS). Previous reports indicate that DCS can result in personality change, depression, Munchausen's syndrome, and pseudo stroke. We report two cases of acute psychoses that occurred following diving as suspected DCS and were treated with hyperbaric oxygen, which did not improve the psychotic features. One patient had symptoms of DCS including myalgias, weakness, and fatigue; however the symptoms were inconsistent. The symptom onset and nitrogen loading from his dive profiles made the diagnosis of DCS unlikely. The second patient exhibited mild joint pain, fatigue, and psychosis that was temporally associated with diving but no other symptoms of DCS. Following a detailed medical evaluation we determined that these two patients did not have DCS or arterial gas embolism (AGE). Although it is highly unlikely that a pure psychotic episode will arise as a result of DCS, physicians caring for divers with symptoms of DCS or AGE and acute psychosis may consider a trial of recompression therapy while completing the medical evaluation. Divers with acute psychosis without signs and symptoms and benign dive profiles are unlikely to have DCS or AGE.
Hopkins
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Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA.
Weaver
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D000208:Acute Disease; D000328:Adult; D003665:Decompression Sickness / Q000150:complications / Q000523:psychology; D004213:Dissociative Disorders / Q000209:etiology*; D004242:Diving / Q000009:adverse effects / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology; D011618:Psychotic Disorders / Q000209:etiology*; D013315:Stress, Psychological / Q000209:etiology*