Bipolar disorder in aviation medicine

BACKGROUND: One of the most difficult challenges in aviation medicine is to diagnose, as early as possible, pilots with psychiatric disorders that may impair pilot performance and increase the risk of incidents and accidents. This diagnosis applies particularly to bipolar disorder (BD), where return to flying duty is not an option in the majority of cases. BD is a long-term mental disorder presenting remittent depressive, hypomanic, manic, or mixed episodes between low symptomatic or asymptomatic intermediate periods. Onset in most cases is in late teen or early adult years. Suicidal intentions and suicide risk are significantly elevated in individuals with BD compared to the general population. METHODS: A systematic literature search was performed of BD and aviation accidents and the National Transportation Safety Board database of fatal general aviation accidents was searched. One case report and two database reports of interest from 1994 to 2014 were identified. RESULTS: The findings set a minimum frequency of BD in general aviation fatalities to be approximately 2 out of 8648 (0.023%) in the United States. DISCUSSION: The reported incidence may underestimate the real number of BD cases for several reasons, including the fact that the medical history of pilots is not always available or is sometimes not the primary interest of a safety investigation. This study suggests that the demarcation of psychiatric disorder related to fitness to fly is an important step in safety.