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Psychiatric - Miscellaneous

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hope you can help me out on a little problem I have with a client.He is a certified diver and dived with us 1 day prior to starting an Advanced course. When filling out the medical questionaire, we were made aware that he is on prescription, which our doctor here is unsure of and has therefore stopped him from diving until the position can be made clear. The prescription is Triflouruperazine and Procyclidine prescribed by a consultant psychiatrist. The client says it is to reduce voices that he hears on occassions.

A - Would be grateful if you could verify the diving situation for this client, as he is obviously very disappointed to come all this way to dive. He will be leaving us in a few days.
Sadly I think that this diver should not really be in the water. The voices that he is hearing are a classic symptom of a psychosis. They are known as auditory hallucinations and are a symptom of schizophrenia. The medication that he is taking is a called a phenothiazine and has a wide side effect profile including seizures and blurred vision. Another side effect is called a "tardive dyskinesia", where the mouth and lips go into a sort of spasm. So you can see the dangers of diving if these were to occur. The procyclidine part of the treatment is supposed to stop some of the side effects however one of the problems with this condition is that the medication is often forgotten and the symptoms come back under stress or anxiety.

Hence my advice that he would be better off not taking the risk of diving.

This, though does bring up another issue. That of disappointed divers arriving on their holiday only to find that they are unable to dive. I think that its about time that some of the holiday companies double check the client's medical history before they pay for the holiday. This can so easily be done by simply including the questionnaire from the PADI dive form in the brochure on on their websites, then a "yes" to any of the questions and the potential client knows to get medical clearance before going ahead and booking the trip.

This would have saved this person a 4000 mile trip to find out all he could do was lie on the beach.

Q - I am having a problem getting my doctor to sign my medical form for a PADI Open Water course. This is because I ticked 'yes' for having or ever having claustrophobia. I used to occasionally feel claustrophobic on buses and I had trouble when I went caving once. However I do not feel claustrophobic in water and I never have done.

Please could you tell me your opinion.

A - This is where a little common sense is needed. Claustrophobia is on the PADI form as a no-no to diving. But there are many shapes and forms of this psychological phenomenon. In most dives the only enclosed space you will find is your mask and the bogs on board a boat. So you would have to have an extreme version of this problem to find this debilitating.

I think that if you are OK with a mask and don't do the swim throughs or caves or wreck penetration then all will be fine.

In these circumstances I don't really need to see a patient but can take their word on it by email. There's not a lot I can tell from seeing you face to face that would enlighten me about your problem. Unless I put you in a small box.

So send me your forms and I will post them back to you, all signed up. The only cost is a fiver to the RNLI. A fine charity whom once saved me when I was the worlds worst surfer.

(other dive medical questions)


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