Mental Health

Published on 14/03/2015 by admin

Filed under Emergency Medicine

Last modified 22/04/2025

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Mental Health

Psychiatric problems can emerge or worsen in response to the demands of wilderness experiences. Even in the absence of psychiatric disease, travel produces some level of stress in everyone. Psychodynamic issues develop in most groups and threaten to derail those without a plan to deal with them. Management of emotional problems in the wilderness, including the use of psychotropic medications, both in people who have preexisting psychologic difficulties and in those who develop new emotional problems in the wilderness, is outlined in this chapter.

Modern interpersonal theory suggests that most healthy adults cope with stress by flexibly using different coping styles, but that all adults develop an inflexible coping style under extreme stress. Individuals vary with regard to the magnitude of stress they can endure before innately settling into one of these styles, which was developed in infancy as a response to caregivers. The key to successfully intervening once one of these coping styles becomes inflexible is to challenge the core belief rather than reinforce it, respond to the core belief and not the behavior displayed, and to avoid reinforcing the coping style.

1. Moving toward others:

2. Moving away from others:

3. Moving against others:

Depression (with or Without Mania)

Symptoms

A wilderness traveler who has been divorced, widowed, or fired from his or her job shortly before the trip may be at higher risk for suicide. A family history of suicide or a history of suicidal behavior increases suicide risk. If there is a concern that someone might be suicidal, then he or she should be asked about suicidal thinking in a straightforward and concerned manner. Asking about suicide does not increase suicide risk. If the suicide potential is judged to be significant, then the person must be watched closely. People who are delirious or psychotic can suddenly become impulsively suicidal in the midst of their confusion and frenzy. Suicidal individuals should be evacuated.

Mania

During the early part of the manic phase of bipolar disorder, sometimes known as hypomania, the person may exhibit positive behavior, productivity, hard work, high energy, and expansive thinking. However, as the person becomes manic, he or she may exhibit the following:

Schizophrenia

Substance Abuse Disorders

People who abuse illicit drugs or alcohol should not be on wilderness adventures; they are a hazard to themselves and others. Some people may be unaware of the depth of their substance abuse problem until they start to experience physical or psychologic withdrawal. Cocaine, methamphetamines, or narcotic abusers will not experience life-threatening withdrawal, but their symptoms can be extremely uncomfortable and disabling. Withdrawal from substances such as cocaine (i.e., “crashing”) is associated with extreme irritability and fatigue. Aches and pains that are typical of influenza are seen in association with withdrawal from narcotics. Withdrawal symptoms may last several days.

Alcohol and benzodiazepine withdrawal are medical emergencies.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a disorder that occurs after someone has experienced an event that involved injury or death or the threat of same. It can also occur following an extreme emotional or physical stress, witnessing a catastrophe, or other profoundly emotional or disruptive occurrence. It is not uncommon in soldiers after combat or persons who have responded to disasters or witnessed immense suffering. PTSD is commonly defined as lasting 30 days or more after the inciting event(s).

Symptoms

1. Reliving the event, including “flashbacks,” nightmares, upsetting memories, and periods of emotional disturbance when reminded of an event. Images and memories may be suppressed for a period of time. There may be fear provoked by the thought of encountering situations similar to what caused the PTSD and seeming loss of bravery or blunted compassion.

2. Disruption of the activities of daily living, manifested by avoidance behaviors. This includes apathy, a feeling of detachment, blunted or flat affect resembling depression, lack of joy and enthusiasm for activities, and failure to appreciate a purpose in what one is doing. In some circumstances, mood may become labile. Anger is not uncommon.

3. Difficulty concentrating and becoming hypervigilant or fearful in situations that resemble the PTSD causation. Persons may startle easily, have periods of anger or sadness, feel generally unsettled, and suffer from poor sleep. It becomes difficult to make decisions.

4. If a person has been witness to a catastrophic or horrible event, he or she may feel “survivor guilt.” In addition, there may be elements of emotional shock, grief, resentment, helplessness, and hopelessness. There may also be frank depression, alcohol or drug abuse, severe anxiety, and panic attacks.

5. Physical symptoms include headaches, easy startling, tachycardia, loss of appetite, loss of sex drive, and muscle aches.

Treatment

1. Persons who have experienced a traumatic event should share emotional support, eat and sleep properly, rest when fatigued, and maintain communications with friends and family.

2. Available evidence indicates that psychologic debriefing is not associated with benefits and may in fact complicate recovery after a disaster. Debriefing, which usually involves some review of the disaster, may increase physiologic hyperreactivity, increase the coding of traumatic memories, and promote rumination about the tragedy; debriefing can thus interfere with more adaptive and natural healing mechanisms (e.g., avoiding thinking about the trauma). If debriefing is used, it should be voluntary, involve clinical assessment, and only be performed by experienced and well-trained individuals.

3. Anxiolytic drugs are not recommended for the treatment of acute PTSD and have been associated with an increased incidence of PTSD.

4. Cognitive therapy may be useful to understand the root cause and achieve desensitization. It is very important after a traumatic event to allow a sufficient period of time to achieve rest, regain a normal menu and pace of activities, and to not be compelled to explain what was done to persons who might not understand.

5. Find outlets for mood swings. Use forms of expression to work through or even purge thoughts of sadness and disappointment.

6. Support groups may be helpful to some patients, but attendance should be voluntary.

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