Item 18m - Mental disroders of any sort

My Flight Surgeon

Sr. Aviation Medical Examiner
This is one of a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.



I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.



Item 18.m. Mental disorders of any sort; depression, anxiety, etc.



This topic always generates a great deal of discussion, especially regarding the medications used to treat many of these conditions. I am going to provide the information that is used in the FAA’s decision making process. Discussion regarding whether or not one should be allowed to fly on medications in the psychotropic, anxiolytic, and antidepressant classes is best discussed in a separate thread.



An applicant with an established history of a personality disorder that is severe enough to have repeatedly manifested itself by overt acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the Examiner. The use of a psychotropic drug is disqualifying for aeromedical certification purposes. This includes all sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including SSRI's), analeptics, anxiolytics, and hallucinogens.



It must be pointed out that considerations for safety, which in the mental area are related to a compromise of judgment and emotional control or to diminished mental capacity with loss of behavioral control, are not the same as concerns for emotional health in everyday life. Some problems may have only a slight impact on an individual's overall capacities and the quality of life but may nevertheless have a great impact on safety. Conversely, many emotional problems that are of therapeutic and clinical concern have no impact on safety. The FAA has concluded that certain psychiatric conditions are such that their presence or a past history of their presence is sufficient to suggest a significant potential threat to safety. An applicant who has a current diagnosis or history of these conditions may request the FAA to grant an Authorization under the special issuance section of part 67 (14 CFR 67.401) and, based upon individual considerations, the FAA may grant such an issuance.



Many of the more common problems encountered follow here:



Adjustment Disorders: Obviously, the airman must submit all pertinent medical information and clinical status reports to the FAA for their consideration. If the condition is stable, resolved, no associated disturbance of thought, no recurrent episodes, and psychotropic medication(s) used for less than 6 months and discontinued for at least 3 months the AME may issue the medical certificate, otherwise the decision lies with the FAA.



Attention Deficit Disorder: The airman must submit all pertinent medical information and clinical status report to include documenting the period of use, name and dosage of any medication(s) and side-effects to the FAA for their consideration in the issuance of a medical certificate. Ritalin (Methylphenidate Hydrochloride) and Adderall (Dextroamphetamine Sulfate) are usually not approved by the FAA. Under rare circumstances, individuals using Ritalin have been approved with restrictions. Approval is more likely for adults due to the difficulty in accurately evaluating ADD in young people and typically requires time off medication prior to flight.



Bereavement or Minor Depression: Again, one must submit all pertinent medical information and clinical status report for consideration. If the condition is stable, resolved, no associated disturbance of thought, no recurrent episodes, and either a) psychotropic medication(s) were used for less than 6 months and discontinued for at least 3 months , or b) there was no use of psychotropic medication(s), the AME may issue the medical certificate. Any other circumstance requires the FAA approve a medical certificate.



Pyschotropic medications for Smoking Cessation: This is the use of Zyban® or other medications to help one stop smoking. There must be documentation of the period of use, the name and dosage of the medication(s) and any side-effects if present. If the medication(s) have been discontinued for at least 30 days and are without side-effects the AME may issue the medical certificate. If these conditions do not exist, the FAA will make the decision regarding the medical certificate. This means you must not fly while taking Zyban®.



Personality Disorder: The category of personality disorders severe enough to have repeatedly manifested itself by overt acts refers to diagnosed personality disorders that involve what is called "acting out" behavior. These personality problems relate to poor social judgment, impulsivity, and disregard or antagonism toward authority, especially rules and regulations. Each of the subsets of personality disorder requires individual consideration by the FAA and their psychiatric consultant before a decision can be made regarding the issuance of a medical certificate.



Psychosis: The category of psychosis includes schizophrenia and some bipolar and major depression, as well as some other rarer conditions. In addition, some conditions such as schizotypal and borderline personality disorders that include psychotic symptoms at some time in their course may also be disqualifying. Each of the subsets of psychosis requires individual consideration by the FAA and their psychiatric consultant before a decision can be made regarding the issuance of a medical certificate.



Bipolar Disorder: A bipolar disorder may not reach the level of psychosis but can be so disruptive of judgment and functioning (especially mania) so as to interfere with aviation safety. All applicants with such a diagnosis must be denied or deferred. However, a number of these applicants, so diagnosed, may be favorably considered for a Special Issuance when the symptoms do not constitute a threat to safe aviation operations. Bipolar disorders require individual consideration by the FAA and their psychiatric consultant before a decision can be made regarding the issuance of a medical certificate. With the exception of herbal preparations (Saint Johns Wort), psychotropic medications, such as lithium, are rarely approved by the FAA.



Anxiety Problems: Although they may be rare in occurrence, severe anxiety problems, especially anxiety and phobias associated with some aspect of flying, are considered significant. Organic mental disorders that cause a cognitive defect, even if the applicant is not psychotic, are considered disqualifying whether they are due to trauma, toxic exposure, or arteriosclerotic or other degenerative changes. Anxiety disorders require individual consideration by the FAA and their psychiatric consultant before a decision can be made regarding the issuance of a medical certificate. With the exception of herbal preparations (Saint Johns Wort), anti-anxiety medications, such as Paxil, are rarely approved by the FAA.

 
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