Discusión sobre la necesidad de delimitación de una nueva nosografía psiquiátrica y psicológica. síndrome del accidentado por rayo eléctrico / Discussion on the delimitation of a nosography new psychiatric and psychological need. syndrome of the accident by electric ray

La observación y análisis de las variadas manifestaciones clínicas y secuelas que presentan las víctimas sobrevivientes de accidente por rayo, nos proporciona la posibilidad de cambiar el punto de vista desde el cual consideramos y estudiamos las mismas. Debemos evaluar la conveniencia de considerar tales manifestaciones meramente como un conjunto de signos y síntomas inespecíficos o pertenecientes a múltiples síndromes ya tipificados; o bien, abrir una nueva y profunda discusión en torno a la posibilidad de su agrupación y delimitación de una nueva categoría nosográfica psiquiátrica y psicológica. La metodología de la presente investigación se basa en el análisis de gran parte de la casuística extranjera de estos pacientes y la investigación bibliográfica exhaustiva sobre las escasas publicaciones científicas existentes. Asimismo, se revisan distintos procedimientos habituales en el ingreso de estos pacientes a los centros de salud que dificultan el estudio epidemiológico y sanitario de los mismos.

The observation and analysis of the varied clinical manifestations and sequels surviving accident victims presented by ray, gives us the possibility to change the point of view from which we consider and study them. We must assess the appropriateness of considering such manifestations merely as a set of signs and symptoms nonspecific, or belonging to multiple syndromes already described; Alternatively, open a new and profound discussion about the possibility of their grouping and delimitation of a new category of psychiatric and psychological nosographic. The methodology of this research is based on the analysis of much of the world Casuistry of these patients and the comprehensive bibliographic research on the scarce existing scientific publications. Also reviewed various common procedures in income of these patients to health centers, hindering the health and epidemiological study of them.

The role of cognitive training in the neurorehabilitation of a patient who survived a lightning strike. A case study.

BACKGROUND: Lightning-related injuries most often involve impairment of the functions of the central and peripheral nervous systems, usually including cognitive dysfunctions. We evaluated the cognitive deficit of a patient who had survived a lightning strike and measured the improvement after her cognitive training. This therapeutic method appears to be a powerful tool in the neurorehabilitation treatment. OBJECTIVE: The aim of this case study was to prove the beneficial effects of cognitive training as part of the neurorehabilitation after a lightning strike. METHODS: Six neuropsychological functions were examined in order to test the cognitive status of the patient before and after the 2-month cognitive training: phonological short-term memory (digit span test and word repetitions test), visuo-spatial short-term memory (Corsi Block Tapping Test), working memory (backward digit span test and listening span test), executive functions (letter and semantic fluencies), language functions (non-word repetition test, Pléh-Palotás-Lörik (PPL) test and sentence repetition test) and episodic memory (Rivermead Behavioral Memory Test and Mini Mental State Examination). We also utilized these tests in aged-matched healthy individuals so as to be able to characterize the domains of the observed improvements more precisely. RESULTS: The patient exhibited a considerable improvement in the backward digit span, semantic fluency, non-word repetition, PPL, sentence repetition and Rivermead Behavioral Memory tests. CONCLUSIONS: The cognitive training played an important role in the neurorehabilitation treatment of this lightning injury patient. It considerably improved her quality of life through the functional recovery.

Central hyperadrenergic state after lightning strike.

OBJECTIVE: To describe and review autonomic complications of lightning strike. METHODS: Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. RESULTS: A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. INTERPRETATION: The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.

A neurologist's notebook: a bolt from the blue: where do sudden passions come from?

A case of musicophilia arises after a patient is struck by lighting and experiences an "out-of-body," near-death experience.

A case of lightning injury with delayed-onset psychiatric and cognitive symptoms.

A case is presented of a man who was struck by lighting but, per his report, developed psychiatric and cognitive symptoms between 1-2 years after the incident. The case is discussed in light of the literature on lightning injury with particular emphasis on the aetiology of delayed symptoms. In this case it appears that some cognitive dysfunction may have occurred at the time of the lightning injury, but deficits were exacerbated after a delayed-onset of PTSD and other psychiatric symptoms. The author suggests possible mechanisms for delayed memory impairment in cases of lightning injury.

Neurorehabilitation of behavioral disorders following lightning and electrical trauma.

Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, posttraumatic stress disorder, and significant alterations in social and work roles. While the problems resemble those following other kinds of accidents, the injury scenarios for lightning and electrical trauma are unique, and seem to invite more skepticism and controversy in medical and legal realms when the survivors seek help. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for some survivors, often persistent and occasionally progressive, that appear weakly related to litigation status, inconsistently related to injury scenarios, and likely influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, and psychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses on managing symptoms, learning compensatory skills, providing psychosocial support, and preventing maladaptive behaviors. It has been therapeutic for some patients to become activists for better awareness and prevention.

Lightning Strike and Electric Shock Survivors, International.

Prior to1989 no known support group existed for victims of lightning or electrical shock injury and their families. A lightning strike survivor of twenty years, Steve Marshburn, recognized the need both from his personal experience and after meeting two other survivors. With his wife and psychologist, he formed Lightning Strike and Electric Shock Survivors International. The organization has grown nearly one hundredfold from the thirteen who attended the first annual meeting. The support group serves people from around the world, has produced a number of publications, participated in research about these injuries and has become active in prevention activities. This paper will describe some of the factors that have led to such success for the organization.

Skin burn, bilateral iridocyclitis and amnesia following a lightning injury.

PURPOSE: To describe a case of lightning injury restricted to the eyes and facial skin. METHODS: Case history describing the clinical examination of a 54-year-old woman. RESULTS: Following a lightning stroke the patient suffered from a sharply demarcated facial skin burn and bilateral iridocyclitis with raised intraocular pressure. Initially she had amnesia regarding the incident. She recovered on symptomatic treatment, with dry eyes as the only sequela. CONCLUSION: We suggest that a lightning current travelled over the outside of the patient's body facilitated by her wet raincoat, a so-called flash-over. Thereby, she was spared from more severe injury, and only the exposed areas of the face and eyes were affected.

Electrical injury and lightning injury: a review of their mechanisms and neuropsychological, psychiatric, and neurological sequelae.

Exposure to electrical current via industrial or residential accidents or lightning strikes is a serious and growing concern in today's medical community. The sequelae that result are referred to as electrical injury (EI) or lightning injury (LI). The relevant principles in electricity are reviewed with particular attention given to their damaging capabilities on the body. Specific neuropsychological, psychiatric, and neurological signs and symptoms as well as objective measures of psychological and neuropsychological functioning and brain imaging in victims of EI and LI, are reviewed from past research. Important issues relevant to researchers in the field are discussed. Finally, the role that neuropsychology might play in this area is outlined.

Ear injuries caused by lightning: report of 18 cases.

The clinical management and long-term outcome in lightning survivors with substantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984-1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 +/- 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 +/- 2.9 years later) in 11 patients (mean age 52.3 +/- 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.

Neurologic and neurobehavioral effects of electric and lightning injuries.

There are few studies of the effects of electric and lightning injuries (ELI) on the neurologic and neuropsychological status of injured patients. We reviewed records of fourteen patients with ELI injuries seen at our hospital (12 with high-voltage electric and two with lightning injury). Eight had cardiac arrest after injury, and 10 had neurologic complaints when first evaluated. Eight had normal neuroimaging results. Six had electroencephalograms; four showed abnormal results. Thirteen underwent neuropsychological testing. Twelve (92%) showed cognitive dysfunction including impairments in memory, attention, and affective disturbances (anxiety, depression, irritability, and poor frustration tolerance). Five of 12 (62%) had multiple physically aggressive outbursts, not present before the injury. Patients with cardiac arrest did not differ in neurologic psychologic testing from patients not sustaining cardiac arrest. Patients with ELI who had neurobehavioral symptoms had a coherent syndrome characterized by disturbances in cognition (attention and memory), mood (distress with prominent irritability), and behavior (aggressive outbursts). Serial neurologic and neuropsychological evaluations will aid in better defining the sequelae of ELI.

Adolescents' perceived risk and personal experience with natural disasters: an evaluation of cognitive heuristics.

Elevated risk judgments for negative life events have been linked to personal experience with events. We tested the hypothesis that cognitive heuristics are the underlying cognitive mechanism for this relation. The availability (i.e., memory for incidents) and simulation (i.e., imagery) heuristics were evaluated as possible mediators for the relation between personal experience and risk estimates for fatal weather events. Adolescents who had experienced weather disasters estimated their personal risk for weather events. Support was obtained for the simulation heuristic (imagery) as a mediator for the relation. Availability for lightning disaster experience was also found to be a mediator for the relation between personal lightning disaster experience and risk estimate for future events. The implications for risk perception research are discussed.

Children's defensive responses and emotional upset following a disaster: a projective assessment.

Projective stories were used to assess the defense mechanisms of 27 preadolescent boys who were victims of a lightning strike in which one boy died. Denial, projection, and identification, in combination, were found to be inversely related to clinical upset, as was the age and sex-appropriate individual defense of projection. In addition, low-defensive boys' self-reports of fears agreed more often with their parents' reports of sleep and somatic disturbances than did high-defensive boys' self-reports. The findings provide support for the validity of the Defense Mechanism Manual (Cramer, 1982) and raise the issue of defense mechanisms as moderator variables in self-report questionnaires.