Isolated psychosis drives mountaineers to madness, finds science

The Himalayan Times pointed me to this interesting study

Isolated psychosis drives mountaineers to madness, finds science

Scientists from Eurac Research and the Medical University of Innsbruck said that they discovered a new medical entity defining the isolated high-altitude psychosis which could lead the mountain workers and climbers to madness, increasing the risks of accidents as they trekked at heights exceeding 7,000 m above sea-level.

“The mountaineer who suffers psychotic episodes may think he/she is being pursued and starts talking nonsense or changes the route without rhyme or reason.”

Our research on psychotic episodes at extreme altitudes specially covers a new issue that may be interesting and important also for Nepali porters, Sherpas and high-altitude climbers, Hermann Brugger, Head of the Institute of Mountain Emergency Medicine at Eurac Research, told THT. “Research findings are more important in the present context because the syndrome increases the risk of accidents.”

Brugger, the Associate Professor at Innsbruck Medical University, along with Katharina Hüfner, lecturer at the University Clinic in Innsbruck, for the first time, collected around 80 psychotic episodes taken from German mountain literature and systematically analysed the symptoms described in them.

“In our study we found that there was a group of symptoms which are purely psychotic; that is to say, that although they are indeed linked to altitude, they cannot be ascribed to a high-altitude cerebral edema, nor to other organic factors such as fluid loss, infections or organic diseases,” Brugger, who is also the President of International Society for Mountain Medicine, explained.

Here is the study.

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

The Pdf starts off with the

Introduction

‘I first met Jimmy on the Balcony, a cold windswept snow shelf high up on the southeast ridge of Mount Everest. At an altitude of more than 8200 meters our introduction had been brief, with little more than a muffled “hello” and a few words of encouragement passing between us. Over my right shoulder, obscured by the bulky oxygen mask and the rim of down that smothered my face, I was sure I could see Jimmy moving lightly in the darkness. But despite him remaining close by me for the rest of the day, I didn’t see him again’ (Windsor, 2008).

As weird as this might sound, this can happen. Every sincere sportmen can relate that strange sensations do happen when engaging in your sport and you do not have to be above 8.000 meters.

Abstract

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.

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).

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).

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.


Though I would like to caution from the start, this is by no means a scientifc study. Here is why. On page 2 of the Pdf they explain their method:

"Methods

Included cases

The basis for inclusion was a survey of the lay literature relating to mountaineering performed via a search on ‘Amazon.de’ (accessed on 25 July 2014) using the German keyword ‘Bergsteigen’ (mountaineering) and the filter ‘Biographien und Erinnerungen’ (biography and history). The results were sorted by relevance and the first 100 hits were analysed. Additionally, the authors of the study contributed books from their private collections for analyses (Supplemental Material 1). Episodes were identified and extracted from the literature via the following criteria: (1) the minimum altitude of 3500 m was reached; (2a) a detailed description of the episode with at least three somatic or psychiatric criteria (regardless if pathological or normal) were present; or (2b) a significant change in the course of the tour occurred that was not attributable to external circumstances (i.e. turning back, change of target, accident or near accident)."

If you write a book about your climb it makes for boring reading - and that means low sales - when there is not some form of drama narrated, even though your expedition went as smooth as a walk in the park on a Sunday. Still, experiences like the one with Jimmy do indeed happen in one form or another.

Interviews would have been a better way to gain insight, although these also tend to be skewed in hindsight and passage of time.