Biology Reference
In-Depth Information
tangible risk as some studies enrolling patients with baseline generalized anxiety disor-
der (GAD) found a highly significant independent association of GAD with markedly
increased (74%) cardiovascular event rate (Martens et al., 2010). Therefore, such fear
of snakebite can conceivably precipitate a serious cardiovascular consequence in those
with GAD. Additionally, some may suffer localized trauma from unobserved bites or
stings from other nonophidian sources, and attribute the symptoms to a bite from a
snake because they are known to inhabit the geographic region.
Somatosensory amplification and symptom attribution influencing clinical pre-
sentation are common phenomena and can be culturally influenced (Duddu et al.,
2006; Kirmayer et al., 1994). Symptom attribution style and concomitant cultural
mores may contribute to the interpretation of a given somatic complaint (Kirmayer
et al., 1995; Robbins and Kirmayer, 1991). Some evidence suggests that somato-
sensory amplification is neither sensitive nor specific to somatizing states, and other
factors—such as anxiety and/or additional circumstantial factors such as depres-
sion—may have influence (Duddu et al., 2006).
Brief consideration of some representative case scenarios may help illustrate the
potential role of anxiety in somatosensory amplification. Among a series of patients
with minor injuries on the arms or shoulder sustained from grazing bullet wounds or
superficial knife lacerations, several complained of a broad spectrum of symptoms,
including low back pain, chest pain, palpitations, “severe” headache, abdominal
pain/nausea, and lower-limb “numbness”/paresthesia (SAW, personal observations).
Clearly, assessment of these patients should not lead to the inclusion of these symp-
toms as likely direct consequence of either a grazing bullet wound or minor lacera-
tion from a knife. Rather, these are individual autonomic, anxiety-driven responses
(some with somatosensory amplification) to traumatic events that had a marked
psychological effect on the patient (i.e., being shot or attacked by a knife-wielding
assailant in a street altercation). It is noteworthy that in several of these cases, the
patients had previously experienced similar wounds. This did not alter their acute
psychological response. Although the physical pathology was clinically mild, and
the patient's psychological response was partly anxiety driven, the need for clinical
management of the primary presenting complaint remains. Similarly, in the case of
an apparently medically insignificant snakebite inflicted by a species of unknown
medical importance, the physician must evaluate the symptoms with careful systems-
based physical examination and supporting investigations as indicated. The major-
ity of the cases reviewed here (
Table 4.1
) suggest a significant degree of subjective
interpretation by nonmedically qualified authors, and an absence of appropriate for-
mal clinical review (
Table 4.1
; see Section 4.5.1). Therefore, it is likely that some of
these cases carry marked subjective bias toward symptoms interpreted (or misinter-
preted) by the victims themselves and, in some cases, with an anxiety and/or somato-
sensory amplification contribution to the presentation. Although this may simply be
reported as “severe” local effects, occasionally serious disproportionate symptoms/
signs without clear linkage to the inflicted bite are reported (e.g., see Sections 4.4
and 4.5.1;
Table 4.1
). Even experienced field herpetologists may exhibit anxiety after
sustaining a bite from an ophidian species of unknown medical importance. Possibly,
having knowledge of the enlarged dentition and presence of Duvernoy's glands in a
