PSYCHOLOGICAL RESPONSES TO WILDERNESS ACCIDENTS - Medicine for Mountaineering and Other Wilderness Activities - page 42

Overly concerned with small things and neglectful of more pressing, major problems
Denies any problems; overconfident; rejects offers of assistance
Blames the problems on others
Has difficulty making plans or discussing future actions
Severe Derangement
Hallucinations, auditory or visual, unverifiable by others
Verbalizes fear of losing mind; claims the world seems unrecognizable and unreal;
claims body feels unreal and completely different
Preoccupied with an event or idea to the exclusion of anything else
Unrealistic claims that an agency, object, group, or spirit intends to cause harm to self
and to others, such as family or friends
Expresses inability to make a decision to carry out familiar activities
Expresses a real fear of killing or harming self or others; far exceeds simple statement
of anger or hopelessness
EMOTIONAL EXPRESSION
Mild Derangement (significantly different from most individuals but largely appropriate
to situation)
Frequent uncontrolled tearing and weeping; rehashing of traumatic events
Bluntedexpressionoffeelings;apathetic;seeminglywithdrawnemotionallyandunable
to react with feeling to what is happening
Unusual laughter and gaiety
Overly irritable; quick to get angry over trivia
Severe Derangement (markedly unusual affect or emotion)
Excessively flat emotionally; virtually no expression of feeling
Excessive emotional expression; inappropriate joy, anger, fear, or sadness for situation
Trauma or Disease Simulating Psychological Abnormalities
A number of disorders, particularly those that cause hypoxia or metabolic derange-
ments, produce abnormal behavior that simulates abnormal psychological reactions. Hyp-
oxia is common and results from altitude, but it is also produced by pneumonia, chest in-
juries, shock, and other disorders. Hypothermia typically produces changes ranging from
forgetfulness and slow thought processes, through loss of coordination and greater mental
dullness, to irrationality, and finally coma. Hyperthermia can cause headache, irritability,
agitation, and mental dullness before progressing to stupor and coma. Hypoglycemia pro-
ducesrestlessness,irritability,lethargy,poorjudgment,agitation,disorientation,andfinally
coma. Severe hypoglycemia is almost always a complication of diabetes, but milder gluc-
ose depletion occurs in normal individuals who are exhausted and have not maintained an
adequate food intake. Dehydration can produce similar abnormalities.