Effects of carbon monoxide poisoning on temperament

Öz

Aim: The aim of this study was to investigate the effect of carbon monoxide (CO) poisoning on temperament and associated disorders.

Material and Methods: The study was conducted in healthy volunteers and patients who presented to the Emergency Department of Kirikkale University Hospital after exposure to CO. Patients with a carboxyhemoglobin level of ≥10% were considered to have CO poisoning. Patients with psychiatric disease or an illness that could increase CO levels and those who smoked or were using medication were excluded. Healthy volunteers were evaluated once, and CO poisoning patients were evaluated at the time of presentation and 3 months after discharge using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) temperament scale. Repeated analysis of variance was applied for comparisons. A p value of <0.05 was considered statistically significant.

Results: The study included 110 participants: 68 in the CO poisoning group and 42 healthy volunteers. Significant differences between the groups were observed in the TEMPS-A scores for depressive type (p=0.016) and anxious type (p=0.01) at first presentation and for the irritability type (p=0.02) and anxious type (p=0.034) at 3 months after the discharge. When the temperament scale scores of the CO poisoning patients were compared according to evaluation time (first presentation and 3 months after discharge), no significant difference in temperament types was observed.

Conclusion: Although the temperament types related to depression and anxiety were affected after CO poisoning, they did not change completely. Further research is needed to better understand the psychiatric effects of CO poisoning.

Anahtar Kelimeler

• Carbonmonoxide poisoning,emergency department,temperament,psychiatric disorders,temperament scale

Karbonmonoksit zehirlenmesinin mizaç üzerindeki etkisi

Öz

Amaç: Bu çalışma karbonmonoksit zehirlenmesinin mizaç ve ilişkili olduğu bozukluklar üzerindeki etkisini araştırmak amacıyla yapılmıştır.

Gereç ve Yöntemler: Çalışma Kırıkkale Üniversitesi hastanesi acil servisine karbonmonoksit (CO) maruziyeti sebebiyle başvuran hastalar ve sağlıklı gönüllü (SG) katılımcılarla yapıldı. Karboksihemoglobin düzeyi ≥%10 ölçülen hastalar KZ olarak kabul edildi. Psikiyatrik hastalığı veya ilaç kullanımı olanlar ve CO düzeyini yükseltecek hastalığı veya sigara içiciliği olanlar çalışmaya dahil edilmedi. SG bir kere, KZ olanlar ise acil servise ilk başvuru anında taburcu edilirken ve taburcu olduktan üç ay sonra TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionaire) mizaç ölçeği ile değerlendirildi. Grupların karşılaştırılmasında Repeated measures ANOVA testi kullanıldı ve p<0.05 anlamlı kabul edildi. 

Bulgular: Çalışmaya KZ (n=68) ve SG (n=42) olmak üzere toplam 110 katılımcı dahil edildi. Gruplar TEMPS-A mizaç ölçeği puanları bakımından karşılaştırıldığında,  acil servise ilk başvuru anında Depresif (p=0.016) ve Anksiyöz (p=0.01) mizaç, üçüncü ayda ise Irritable  (p=0.02) ve Anksiyöz (p=0.034) mizaç tipi puanlarında anlamlı farklılık saptandı. KZ olan hastaların mizaç ölçeği puanları, değerlendirme zamanına (İlk başvuru zamanı ve üçüncü ay) göre karşılaştırıldığında hiçbir mizaç tipinde fark saptanmadı.

 

Sonuç: KZ sonrası hastaların özellikle depresyon ve anksiyete ile ilişkisi olan mizaç tiplerinde etkilenme olsa da, mizaç özellikleri tamamen değişmemiştir. Karbonmonoksit zehirlenmesinin psikiyatrik etkilerinin daha iyi anlaşılabilmesi için ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• acil servis,mizaç,Karbomonoksit zehirlenmesi,psikiyatrik bozukluklar,mizaç ölçeği

Kaynakça

1. 1. Guzman JA. Carbon monoxide poisoning. Crit Care Clin 2012; 28: 537-48.
2. 2. Sykes OT, Walker E. The neurotoxicology of carbon monoxide-Historical perspective and review. Cortex 2016; 74: 440-8.
3. 3. Aslan S, Uzkeser M, Seven B et al. The evaluation of myocardial damage in 83 young adult with carbon monoxide poisoning in the East Anatolia region in Turkey. Human Experimental Toxicology 2006; 25: 439-46.
4. 4. Kandis H, Katirci Y, Cakir Z, Aslan S, Uzkeser M, Bilir O. A retrospective analyse of the patients admitted to emergency service for carbon monoxide intoxication. Academic Emerg Med J 2010; 5: 21-25.
5. 5. Quinn DK, McGahee SM, Politte LC et al. Complications of carbon monoxide poisioning: a case discussion and review of the literature. Primary Care Companion to the journal of clinical Psychiatry 2009; 11: 74-79.
6. 6. Katirci Y, Kandis H, Aslan S, Kirpinar I. Neuropsychiatric disorders and risk factors in carbon monoxide intoxication. Toxicol Ind Health 2011; 27: 397-406.
7. 7. Prockop LD. The allegory of a mountain: an environmental introduction to neurotoxicology. J Neurol Sci 2007; 262: 7-14.
8. 8. Jasper BW, Hopkins RO, Duker HV, Weaver LK. Affective outcome following carbon monoxide poisoning: a prospective longitudinal study. Cogn Behav Neurol 2005; 18: 127-34.

9. 9. Chambers CA, Hopkins RO, Weaver LK, Key C. Cognitive and affective outcomes of more severe compared to less severe carbon monoxide poisoning. Brain Inj 2008; 22: 387-95.
10. 10. Weaver LK, Hopkins RO, Elliott G. Carbon monoxide poisoning. N Engl J Med 1999; 340: 1290-92.
11. 11. Smith JS, Brandon S. Morbidity from acute carbon monoxide poisoning at three-year follow-up. Br Med J 1973; 1: 318-21.
12. 12. Choi IS. Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol 1983; 40: 433-35.
13. 13. Min SK. A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication. Acta Psychiatr Scand 1986; 73: 80-86.
14. 14. Akiskal HS, Akiskal KK, Haykal RF, Manning JS, Connor PD. TEMPS-A: progress towards validation of a self-rated clinical version of the Temperament Evaluation of te Memphis, Pisa, Paris, and San Diego Autoquestionnaire. J Affect Disord 2005; 85: 3-16.
15. 15. Akiskal HS, Mallya G. Criteria for the soft bipolar spectrum treatment implications. Psychopharmacol Bull 1987; 23: 68-73.
16. 16. Akiskal HS. Toward a definition of generalized anxiety disorder as an anxious temperament type. Acta Psychiatr Scand 1998; 98: 66-73.
17. 17. Eory A, Gonda X, Torzsa P, Kalabay L, Rihmer Z. Affective temperaments: from neurobiological roots to clinical application. Orv Hetil 2011; 152: 1879-86.
18. 18. Akiskal HS, Placidi GF, Maremmani I et al. TEMPS-I: delineating the most discriminant traits of cyclothymic, depressive irritable and hyperthymic temperaments in a nonpatient populaiton. J Affect Disord 2005; 51: 7-19.
19. 19. Vahip S. Affective temperaments in clinically-well subjects in Turkey: initial psychometric data on the TEMPS-A. J Affect Disorders 2005; 85: 113-25.
20. 20. Meert KL, Heidemann SM, Sarnaik AP. Outcome of children with carbon monoxide poisoning treated with normobaric oxygen. J Trauma 1998; 44: 149-54.
21. 21. Rihmer Z, Akiskal KK, Rihmer A, Akiskal HS. Current research on affective temperaments. Curr Opin Psychiatry 2010; 23: 12-8.
22. 22. Aslan AA, Sari BA, Kuruoglu A. From Depressive Symptamotology to Major Depression: Clinical Spectrum. Turkish J Clinical Psychiatry 2012; 15: 56-64.
23. 23. Rihmer A, Rozsa S, Rihmer Z, Gonda X, Akiskal KK, Akiskal HS. Affective temperaments, as measured by TEMPS-A, among nonviolent suicide attempters. J Affect Disord 2009; 116: 18-22.
24. 24. Henry C, Lacoste J, Bellivier F, Verdoux H, Bourgeois ML, Leboyer M. Temperament in bipolar illness: impact on prognosis. J Affect Disord 1999; 56: 103-8.
25. 25. Fistikci N, Hacioglu M, Erek S et al. Differences in affective temperaments in anxiety disorders: comparison of panic disorder and obsessive compulsive disorder. Archives of Neuropsychiatry 2013; 50: 337-44.
26. 26. Moore DJ, Atkinson JH, Akiskal H, Gonzalez R, Wolfson T, Grant I; HNRC Group. Temperament and risky behaviors: a pathway to HIV? J Affect Disord 2005; 85: 191-200.
27. 27. Gale SD, Hopkins RO, Weaver LK, Bigler ED, Booth EJ, Blatter DD. MRI, quantitative MRI, SPECT, and neuropsychological findings following carbon monoxide poisoning. Brain Inj 1999; 13: 229-43.
28. 28. Karaman D, Metin S, Kara K et al. Neuropsychological evaluation of children and adolescents with acute carbon monoxide poisoning. Pediatric Emergency Care 2016; 32: 303-6.
29. 29. Weaver LK, Valentine KJ, Hopkins RO. Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen. Am J Respir Crit Care Med 2007; 176: 491-7.