Isolated psychosis drives mountaineers to madness, finds science

Rajan Pokhrel

KATHMANDU: The mountains can drive the high-altitude travellers to madness, a new scientific research has discovered.

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.

Psychosis can occur at very high and extreme altitude, and reportedly in the absence of other signs and symptoms of HACE, he added. “Isolated HA psychosis should thus be considered a distinct and separate high altitude-related syndrome.”

According to him, the findings have the potential to increase safety at high altitudes, especially when with a partner or in a group. “These findings are not only important for climbers and mountaineers but also for occupational HA work.”

The emergency medicine doctors said they only speculated the causes of psychosis mentioning that it is possible that factors such as oxygen deficiency, the situation of being totally dependent on oneself and the early stages of swellings in certain areas of the brain could all be triggers for the psychosis. “It is important to inform subjects who intend to go to high altitude areas about the possibility of psychosis, in addition to the well-recognised somatic HA disorders.”

Brugger said that they would collaborate with Nepali doctors by undertaking further investigations in the Himalayas in the next spring season. “We hope to find out, inter alia, how frequently this disease occurs. The highest mountains in the world are maddeningly beautiful and it’s just that we had no idea that they could actually drive us to madness as well,” he said.

To better describe high-altitude psychosis, to determine its incidence, risk and trigger factors, treatment and patient’s outcome, a prospective observational study should be performed, according to him.

“Additionally, in vitro studies could further ameliorate knowledge of the underlying pathophysiology since isolated psychosis at altitude shows some clinical features similar to schizophrenia, it could potentially serve as a reversible model of the disease; thus aiding in the investigation of pathophysiological concepts or new treatments for schizophrenia and related disorders.”