A panel of Chinese medical experts has reached a consensus on recommended medications for rapidly and effectively treating symptoms of acute stress disorder (ASD) in pilots.
The goal is to quickly relieve symptoms and restore cognitive function to ensure flight safety.
The experts recommended different medications based on the specific ASD symptoms present.
Key Facts:
- Alprazolam, lorazepam, and eszopiclone are recommended for treating excitatory psychomotor symptoms.
- Paroxetine and sertraline are recommended for psychomotor depressive symptoms.
- Olanzapine, olanzapine orally disintegrating tablets, and quetiapine fumarate are recommended for psychotic symptoms.
Source: BMC Psychiatry 2023
Background on Acute Stress Disorder (pre-PTSD)
Acute stress disorder (ASD) is a psychological condition that can occur immediately after experiencing a traumatic event.
Key symptoms include anxiety, re-experiencing the trauma through intrusive thoughts or dreams, avoidance of trauma-related stimuli, hyperarousal, and dissociation.
SD lasts between 3 days and 1 month. Without treatment, 20-50% of ASD cases develop into post-traumatic stress disorder (PTSD).
ASD in Pilots Poses Safety Risks
For pilots, ASD can be triggered by flight stressors and emergencies.
Experiencing ASD reduces cognitive function, perception, and attention – critical faculties needed for safe flight operations.
Irritability, anxiety, increased heart rate and blood pressure, and operational errors may also occur.
Timely and effective treatment of ASD in pilots is crucial for restoring cognitive abilities and ensuring flight safety.
Medications can rapidly control symptoms and prevent behavioral changes in the short-term.
This new expert consensus identifies optimal medications for different ASD symptoms in pilots.
The Need for Specialized Treatments in Acute Stress
Currently, there are no formal guidelines on pharmaceutical treatments specifically for ASD in pilots.
General ASD treatment guidelines recommend medications like sertraline, paroxetine, fluoxetine, venlafaxine, and risperidone.
However, pilots represent a unique population with specialized needs.
Adverse medication effects like drowsiness and impaired attention could endanger flight safety.
The experts aimed to identify medications that rapidly relieve ASD symptoms in pilots while avoiding side effects that impact cognitive function.
Additionally, ASD has diverse symptoms that may benefit from different medications. Existing guidelines don’t match medications to specific symptoms.
The Delphi Technique: Expert Panel Consensus Treatment
To develop new, pilot-specific ASD treatment recommendations, the researchers used the Delphi technique.
This involved iterative rounds of consultation with a panel of experts to build consensus.
16 leading Chinese experts in psychiatry, pharmacology, and aerospace medicine participated.
The panel included professionals with senior job titles and over 10 years of experience.
In the first round, the experts evaluated 17 commonly used ASD medications for feasibility and likelihood of use in pilots.
After reviewing results, 7 medications advanced to the second round, where experts re-evaluated them along with 7 newly suggested options.
Finally, in a group discussion, the experts reached full consensus on the best medications to prescribe for different ASD symptoms in pilots.
Medications for Excitatory Psychomotor Symptoms
The most common ASD profile involves hyperarousal and anxiety.
The experts recommended 3 medications for excitatory psychomotor symptoms:
Alprazolam
- High potency benzodiazepine approved for treating anxiety and panic disorders
- Rapidly reduces corticosterone levels and anxiety
- Given to pregnant women, suggesting a high safety profile
Lorazepam
- Also a benzodiazepine, effective for acute anxiety attacks
- Safe for use in the elderly
Eszopiclone
- Non-benzodiazepine sedative-hypnotic
- Improves sleep quality, which helps emotional processing and symptom relief
- High biological activity and few adverse effects
Medications for Psychomotor Depressive Symptoms
ASD may also involve psychomotor inhibition – emotional numbness, depression, and withdrawal. The experts recommended 2 SSRI antidepressants for these symptoms:
Paroxetine
- FDA approved for PTSD
- Reduces trauma-related numbness and avoidance
- Considered safe and tolerable
Sertraline
- Also FDA approved for PTSD
- Lowers hyperarousal, avoidance, and numbness
- Safe for use in children, suggesting mild side effects
Medications for Psychotic Symptoms
Some ASD patients experience detachment from reality, paranoia, or hallucinations.
The experts recommended 3 atypical antipsychotics to treat psychotic symptoms:
Olanzapine
- Enhances cognitive function more than other antipsychotics
- Reduces irritability, aggression, insomnia
- Safe for use in children
Olanzapine ODT
- Orally disintegrating tablet for fast absorption
Quetiapine
- Reduces flashbacks, hyperarousal, anxiety, and depression
- Well tolerated with few side effects
Expert Decision Considerations: Side Effects, Pilot Performance, Efficacy
The expert panel ruled out medications with side effects that could impair pilot performance, like sedation and cognitive dysfunction.
Their choices were informed by factors like:
- Speed of symptom relief
- Impact on cognitive function
- Side effect profile
- Safety data and FDA approvals
- Research on effects in trauma patients
Benefits of Specialized Treatment Guidelines for Pilots
This new expert consensus bridges a gap in specialized guidelines for pharmacotherapy in pilots with ASD.
The recommendations offer pilots rapid relief from distressing symptoms while avoiding adverse effects that could impact flight safety.
Selecting medications specifically shown to enhance cognitive function should improve recovery outcomes.
Matching medications to symptom profiles may also increase effectiveness.
The research also highlights the need for additional studies exploring ASD treatment responses uniquely in the pilot population.
Future findings can contribute to enhanced guidelines.
Ultimately, these new recommendations can help optimize pharmacological management of ASD in pilots.
Ensuring pilots receive effective treatment supports both their mental health recovery and aviation safety.
References
- Study: Consensus on the pharmacological treatment of acute stress disorder in Chinese pilots: a Delphi study
- Authors: Xing Gao et al. (2023)
