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ICAO Preliminary Unedited Version — October 2008 III-9-2
document contains detailed descriptions of the diagnostic requirements, which may be useful for their application to
medical assessment.
Any mental condition which the applicant experiences or has experienced in the past must be assessed to
ascertain the associated functional deficit. The examiner must also consider the risk of recurrence of any
disabling psychiatric condition. Furthermore, many psychiatric conditions exist co-morbidly with other
psychiatric conditions and particularly with abuse or misuse of psychoactive substances. The examiner
must also be aware that, although the psychiatric condition may have responded well to treatment, the
demands of the aviation environment are such that virtually any decrement in cognitive ability may have
significant consequences.
In order to control an aircraft, aircrew members need:
a) to know their position in space, which requires adequate sensory input (sight, hearing, balance,
proprioception, etc.);
b) to evaluate flight conditions and to choose a safe course to ensure the aircraft arrives safely at its
destination, which requires the capacity to acquire information, process the information, and
make relevant decisions;
c) the physical capacity and the mental desire to carry out the chosen course of action.
Psychiatric conditions can cause an aircrew member to become incapacitated, which may be obvious or
subtle, and the task of the medical examiner is to detect this or the likelihood thereof on the basis of the
regulatory examination.
PREDISPOSITION TO PSYCHIATRIC ILLNESS
The predisposition to psychiatric illness is a combination of nature, nurture, and life events.
The study of human genetics and the natural history of many psychiatric illnesses have made it evident
that many conditions have a significant genetic component. It is now generally accepted that even human
temperament has a significant genetic component. Although the genetic studies of psychiatric conditions
including temperament are still in their infancy, it is to be expected that within a few decades, it will be
possible to predict the emergence of mental illnesses in predisposed individuals.
This genetic predisposition, which may be stronger or weaker, is modified by life experiences related to
childhood rearing or life events, which may result in the overt expression of a psychiatric illness. Persons
with only a weak genetic predisposition may be able to withstand more nurture and/or life event stressors
without expressing manifest psychiatric symptoms. In particular the study of psychiatric casualties of war
and victims of disasters has demonstrated that no one is immune to the development of psychiatric
symptoms when exposed to severe stressors.
In many cases, a psychiatric illness of adulthood has a harbinger of this illness in childhood and may be
preceded by dissocial behaviour, poor academic achievement, difficulty in finding regular employment,
use of addictive substances, anxieties, mood disorders, and attachment failures. A history of any of these
should lead the medical examiner to attempt to gather further information from family, schools or health
care providers.
ICAO Preliminary Unedited Version — October 2008 III-9-3
PSYCHOLOGICAL TESTING
Psychological testing of aircrew members is rarely of value as a screening tool. Personality tests alone
have not been proven to be reliable tools to predict mental disorders or to assess with any degree of
certainty an applicant’s suitability for an aviation career. In general, the ability to pass the pilot ground
school course is proof of adequate intelligence. Personality inventory testing may be of value in the hands
of a psychiatric consultant when used as an adjunct to a psychiatric evaluation. Specific testing may be
conducted for research and/or treatment purposes.
In neuropsychiatric conditions, sophisticated neuropsychological tests can be of benefit to determine the
degree of cognitive, volitional and behavioural effect caused by the illness/injury. These tests can be used
to monitor the progress of a neuropsychiatric disease process and may be conducted at intervals for this
purpose.
PSYCHIATRIC DISORDERS IN AVIATION PERSONNEL
In this chapter, the classification of psychiatric disorders follows that of the ICD-10 Classification of
Mental and Behavioural Disorders of the World Health Organization (1992). There will be a crossreference
to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American
Psychiatric Association where there are significant differences.
MOOD DISORDERS
Depressive mood disorders (DSM-IV: Major Depressive Disorder) are common disorders which present
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Manual of Civil Aviation Medicine 2(13)
