Page 13 - Volume 10 Number 11

Association publishes a thick book called Diagnosis and Statistical Manual of Mental Disorders in an attempt to accurately describe a variety of conditions and what must be present to diagnose them. The most recent iteration of this series is Volume V and this Bible of Psychiatric Diagnosis is called DSM-V. This book is used in conjunction with the World Health Organization’s “International Classification of Diseases” (ICD-11) as the standard for the diagnosis of mental conditions.
DSM-V is quite complex. Mental conditions are broken down into 20 major groups, including Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, Depressive Disorders, Anxiety Disorders, Personality Disorders, Neurocognitive Disorders and so on. The diagnoses described are grouped according to age of onset, internal factors like anxiety, mood changes, and physical symptoms, as well as external factors like disturbances of conduct, impulsive behavior, substance abuse and so on.
As you might imagine, the various groups overlap in many ways and this can lead to confusion in the precise classification of a specific patient. It is this uncertainty that makes the FAA uncomfortable. It is also why it can be difficult to get a Special Issuance (SI) for psychiatric diagnoses. In evaluating a diabetic or cardiac patient for an SI, the FAA has objective data to use in
making its decision. Such objective data is lacking in most psychiatric situations and therefore psychiatric conditions are problematic when it comes to deciding who should be allowed to fly and who should not.
Let’s consider some specific diagnosis and see how they can affect a pilot’s ability to obtain or maintain a medical certificate.
Many psychiatric conditions are clearly incompatible with flying. Schizophrenia and disorders where the patient is out of touch with reality are clear examples. Patients who have a history of suicidal ideation form another group that will not, and should not, be medically certified. The crash of Germanwings 9525 in 2015, where the first officer locked the captain out of the cockpit and flew his Airbus into a mountain, thereby simultaneously committing suicide and murdering 149 innocent bystanders brought this issue into clear focus. There is clearly a problem with these diagnoses, as medical ethics prevents a physician from divulging information about their patients, but if a pilot is diagnosed with a significant psychiatric disorder and fails to report it on his FAA medical application, there is a good chance it will not be discovered by the examiner. This issue of patient confidentiality versus aviation safety is a hot topic for certification and regulatory agencies worldwide.
NOVEMBER 2016
KING AIR MAGAZINE • 11