Assessment of Psychotic Symptoms in Individuals Exposed to Very High or Extreme Altitude: A Field Study.

Katharina Hüfner,Paolo Fusar-Poli,Evelyn R Pircher Nöckler,Fabio Caramazza,Agnieszka E Stawinoga,Iztok Tomazin,Hermann Brugger,Buddha Basnyat,Barbara Sperner-Unterweger,Sanjeeb S Bhandari,Monika Brodmann Maeder,Giacomo Strapazzon

doi:10.1089/ham.2020.0210

Abstract

Hüfner, Katharina, Fabio Caramazza, Agnieszka E. Stawinoga, Evelyn R. Pircher Nöckler, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Barbara Sperner-Unterweger, and Hermann Brugger. Assessment of psychotic symptoms in individuals exposed to very high or extreme altitude: A field study. High Alt Med Biol. 22:369–378, 2021.Background: Symptoms of psychosis such as hallucinations can occur at high or extreme altitude and have been linked to accidents on the mountain. No data are available on how to assess such symptoms in the field and what their prevalence or predisposing factors might be.Methods: In this field study at Everest Base Camp (5,365 m) in Nepal, 99 participants of organized expeditions underwent 279 assessments: The High Altitude Psychosis Questionnaire (HAPSY-Q), the Prodromal Questionnaire, 16-items (PQ-16), and the Mini International Neuropsychiatric Interview (M.I.N.I., psychosis section) were collected together with further clinical data. Statistical analysis was done for each phase, that is, altitude range of the climb, and overall data.Results: One of 97 climbers fulfilled the M.I.N.I. diagnostic criteria for psychosis during one acclimatization climb. At least one endorsed item on the HAPSY-Q and the PQ-16, indicating the presence of symptoms of psychosis in the absence of a psychotic disorders, were identified in 10/97 (10.3%) and 18/87 (20.7%) participants respectively. The scores of the HAPSY-Q and the PQ-16 were correlated (r = 0.268, p < 0.001). Odds ratio analysis identified an increased risk for accidents in individuals with endorsed items on the HAPSY-Q.Conclusions: The diagnosis of high altitude psychosis is rare in climbers during organized expeditions. Nevertheless, subdiagnostic symptoms of psychosis occurred in a significant proportion of climbers. Future research is needed to validate these pilot findings.

Highlights

Medical knowledge on somatic symptoms, which can occur at high altitude (HA), has improved over the past decades, as has the awareness of such symptoms in mountain climbers and mountaineers
Two participants were excluded from the study
The main findings of this field study performed at Everest Base Camp (EBC) were as follows: (1) only one individual (1/97) fulfilled the diagnostic criteria for psychosis during HA exposure according to M.I.N.I. diagnostic interview; (2) at least one endorsed item on the High Altitude Psychosis Questionnaire (HAPSY-Q) and the PQ-16, indicating the presence of symptoms of psychosis, was identified in 10/97 (10.3%) and 18/86 (20.9%) participants, respectively; (3) scorings of the HAPSY-Q ‡ 1

Summary

Introduction

Medical knowledge on somatic symptoms, which can occur at high altitude (HA), has improved over the past decades, as has the awareness of such symptoms in mountain climbers and mountaineers. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), lists the following core symptoms for the dimensional assessment of psychosis: hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms; and impaired cognition, depression, and mania (American Psychiatric Association, 2013). Two of these symptoms have to be present for the diagnosis of psychosis, with one of them being hallucinations, delusions, or disorganized speech. Psychotic symptoms are transdiagnostic (Fusar-Poli et al, 2017); they are hallmark of schizophrenia, but can occur in mood or substance abuse disorders, or as part of the syndrome of organic brain dysfunction (classified as delirium in DSM-5) (American Psychiatric Association, 2013)

Results

Discussion

Conclusion