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Isolated psychosis during exposure to very high and extreme altitude – characterisation of a new medical entity

  • Katharina Hüfner (a1), Hermann Brugger (a2) (a3), Eva Kuster (a1), Franziska Dünsser (a1), Agnieszka E. Stawinoga (a4), Rachel Turner (a2) (a3), Iztok Tomazin (a5) and Barbara Sperner-Unterweger (a1)...
Abstract
Background

Psychotic episodes during exposure to very high or extreme altitude have been frequently reported in mountain literature, but not systematically analysed and acknowledged as a distinct clinical entity.

Methods

Episodes reported above 3500 m altitude with possible psychosis were collected from the lay literature and provide the basis for this observational study. Dimensional criteria of the Diagnostic and Statistical Manual of Mental Disorders were used for psychosis, and the Lake Louise Scoring criteria for acute mountain sickness and high-altitude cerebral oedema (HACE). Eighty-three of the episodes collected underwent a cluster analysis to identify similar groups. Ratings were done by two independent, trained researchers (κ values 0.6–1).

Findings

Cluster 1 included 51% (42/83) episodes without psychosis; cluster 2 22% (18/83) cases with psychosis, plus symptoms of HACE or mental status change from other origins; and cluster 3 28% (23/83) episodes with isolated psychosis. Possible risk factors of psychosis and associated somatic symptoms were analysed between the three clusters and revealed differences regarding the factors ‘starvation’ (χ2 test, p = 0.002), ‘frostbite’ (p = 0.024) and ‘supplemental oxygen’ (p = 0.046). Episodes with psychosis were reversible but associated with near accidents and accidents (p = 0.007, odds ratio 4.44).

Conclusions

Episodes of psychosis during exposure to high altitude are frequently reported, but have not been specifically examined or assigned to medical diagnoses. In addition to the risk of suffering from somatic mountain illnesses, climbers and workers at high altitude should be aware of the potential occurrence of psychotic episodes, the associated risks and respective coping strategies.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Author for correspondence: Katharina Hüfner, E-mail: katharina.huefner@tirol-kliniken.at
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Psychological Medicine
  • ISSN: 0033-2917
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