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1 December 2007 New-Onset Anxiety Disorders at High Altitude
Peter J. Fagenholz, Alice F. Murray, Jonathan A. Gutman, John K. Findley, N. Stuart Harris
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Objective.—Studies on the neurologic effects of high-altitude travel have focused on psychometric and cognitive testing and the long-term effects of hypoxia on memory and cognition. Few authors have discussed overt clinical psychiatric illness during high-altitude travel, and those few have focused on patients with preexisting psychiatric diagnoses. We describe a series of patients with new-onset anxiety disorders at high altitude treated at the Himalayan Rescue Association (HRA) clinic in Pheriche, Nepal (4240 m) in the spring season of 2006.

Methods.—We report on all 6 cases of anxiety-related illness diagnosed at the HRA Pheriche Clinic during the spring season, 2006. Three cases, representing the 3 discrete types of illness we encountered, are described in detail.

Results.—Six of 76 foreign patients and none of the 224 Nepalis seen during the season had anxiety-related primary diagnoses. None of the 6 patients had a history of psychiatric disorders or anxiety-related problems at low altitude. Three of the 6 patients were seen after hours, and all 6 required multiple visits. We describe 3 types of anxiety-related disorders: limited-symptom panic attacks induced by nocturnal periodic breathing, excessive health-related anxiety, and excessive emotionality.

Conclusions.—Anxiety-related illness requires significant use of medical resources by high-altitude travelers. Further research is needed to define the epidemiology of anxiety-related disorders at high altitude, to quantify the contributions of various etiologic factors, and to identify safe, effective treatments.

Peter J. Fagenholz, Alice F. Murray, Jonathan A. Gutman, John K. Findley, and N. Stuart Harris "New-Onset Anxiety Disorders at High Altitude," Wilderness & Environmental Medicine 18(4), 312-316, (1 December 2007).
Published: 1 December 2007

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altitude sickness
anxiety disorder
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