Germanwings

[Ike Bana]

I don't believe it's appropriate to have both schizophrenia and bipolar disorder listed as primary diagnoses. People who have psychotic and mood disorder symptoms together are properly diagnosed with something called schizoaffective disorder.

There are also cases where bipolar sufferers have such severe mania with pressured speech so intense that they can't get the words out fast enough to express the furiously racing thoughts they're having, and they start skipping around from one idea to the next so rapidly that they don't make any sense. They are often diagnosed with bipolar disorder w/psychotic features (just "features", not an actual psychotic condition), where the primary diagnosis is the bipolar disorder.

Dual diagnosis is a specific condition where the client suffers from a mood disorder or psychotic disorder with comorbid substance abuse or dependency issues.

[donquixote99]

Originally Posted by JJIII

This may play in with what Ike said above.

http://www.nytimes.com/2015/03/29/wo...-say.html?_r=0

Andreas Lubitz, who was flying the Germanwings jetliner that slammed into a mountain in the French Alps on Tuesday, sought treatment for vision problems that may have jeopardized his ability to continue working as a pilot....

Robin Williams took his life after learning he had a disease that would take away his ability to work as a performer.

There is more to it, certainly, that led our pilot to want to take 149 others with him. Anger and malice are clearly part of the motivation mix in murder-suicide.

[Ike Bana]

Originally Posted by BeamOn

Very good post Ike and I totally agree with you. Question still remains how is a Psychiatrist to detect this mental condition and how accurate will this be?

Second, one can pass new regulations on medical reporting but how is a doctor to know unless the patient tells the doctor what he or she does for a living. Or will airlines be now required to conduct psychiatric evaluations of their pilots? I find this unfeasible and ineffective. Having three crew members with a minimum of two in the cockpit seems to be the only logical solution. But are there enough pilots in the world capable of flying commercial jets?

I flew to the east coast last weekend on an A321 and we had three crew members. Is this SOP in the US for this type of aircraft?

There are complete diagnostic criteria in the DSM for diagnosing things like anti-social personality disorder (what most sociopaths are diagnosed with), and more rare stuff like reactive attachment disorder. I disagree with many colleagues and the DSM regarding the latter condition, which is supposed to be limited to people under 18. I don't want to take the time to go into what all reactive attachment disorder is all about beyond it being a condition where the patient has absolutely no ability to develop interpersonal attachment, and is often hostile and predictably violent toward other people. No sympathy, no empathy, no conscience, no mercy...no nothing. It's like the characters on The Following. The Following is like what a world full of people with reactive attachment disorder would be like. Anyway...it's pretty reasonable that a forensic clinician could put together a pretty accurate post-mortem profile on somebody from reports provided by close family, friends and co-workers.

Regarding you second paragraph...I don't know any mental health professional who does not ask about a client's work history, career interests, and current employment status. It's pretty automatic. That said...after this incident your question regarding evaluations certainly seems vital. And your intervention pretty appropriate.

[Ike Bana]

Originally Posted by JJIII

This may play in with what Ike said above.

http://www.nytimes.com/2015/03/29/wo...-say.html?_r=0

That's interesting...I suppose the guy could have had something organic going on in there. Tumor or some vascular issue. But I would still question the decision making to kill a bunch of other people...its sociopathic behavior and that is typically a severe emotional problem, not really a mood or thought disorder problem. Again, just my opinion.

[JJIII]

Originally Posted by Ike Bana

That's interesting...I suppose the guy could have had something organic going on in there. Tumor or some vascular issue. But I would still question the decision making to kill a bunch of other people...its sociopathic behavior and that is typically a severe emotional problem, not really a mood or thought disorder problem. Again, just my opinion.

I was thinking that the sight problem, and consequent possible loss of his job, might be the trigger that allowed him to act on deeper seated problems.

[HarmanKardon]

The organization of the German pilots is against the planned amendment of the medical secrecy law.

Okay - you are a pilot. You got mental problems (depression etc) and you go to the doctor. The doctor gives you a treatment (fine) and reports your Superiors and they take your flight licence away (not so fine). So you better keep your mental problems secret, and the mental problems not treated.

There is no solution for the problem. The only thing is to accept that aviation will always bear a residual risk.

[Ike Bana]

Originally Posted by JJIII

I was thinking that the sight problem, and consequent possible loss of his job, might be the trigger that allowed him to act on deeper seated problems.

I was sort of thinking the other way, some more direct effect of some organicity in his brain that could have caused some psychosis or early onset dementia of some sort. But that still doesn't change the fact that it's the act of a sociopath, and that's not a chemical imbalance problem...it's emotional/behavioral issues.

[Ike Bana]

Originally Posted by HarmanKardon

The organization of the German pilots is against the planned amendment of the medical secrecy law.

Okay - you are a pilot. You got mental problems (depression etc) and you go to the doctor. The doctor gives you a treatment (fine) and reports your Superiors and they take your flight licence away (not so fine). So you better keep your mental problems secret, and the mental problems not treated.

There is no solution for the problem. The only thing is to accept that aviation will always bear a residual risk.

Well sure...but it's not just a problem for the public at large with airline pilots. While I worked on a hospital psych unit (back in 1993) there were several cases...all older guys...who were admitted and ultimately diagnosed with a DSM disorder (typically depression or anxiety), and identified to be "..a risk for harm to self or others." Not happy when they found out that this invalidated their gun licenses and that they had to get rid of them. With one guy...an ex-cop in his mid 70's, it got pretty ugly on the unit. He trashed his room and became pretty impossible to manage for a while. Which, I suppose, suggested that getting the guns away from him was probably appropriate. I'm fairly certain Illinois law is the same for conditions like Alzheimer's and other dementia.

So there are plenty of gun owners out there (pilots, cab drivers, corporate executives, doctors) who would qualify as being disturbed enough to have their guns taken away, but smart enough and still in control enough to keep it from happening. Pretty scary indeed.

[JJIII]

Originally Posted by Ike Bana

I was sort of thinking the other way, some more direct effect of some organicity in his brain that could have caused some psychosis or early onset dementia of some sort. But that still doesn't change the fact that it's the act of a sociopath, and that's not a chemical imbalance problem...it's emotional/behavioral issues.

You certainly have more training and experience in the field than I, so I bow to your assessment.

Now, what do we do about changing regulations for the future safety of passengers/crew?

[HarmanKardon]

Always stoned: School bus driver Otto!