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frank manic episodes and/or depressions. Consequently, they should be considered unfit for licensing.
SCHIZOPHRENIA AND DELUSIONAL DISORDERS
The schizophrenic illnesses are disorders of thinking and perception. These disorders tend to occur in
early adulthood (primarily in the 20’s), often after a prodromal stage of several years. The perceptual
disturbances most commonly take the form of auditory hallucinations, but may also involve visual or
somatic hallucinations. The presence of delusions, often persecutory, along with the hallucinations may
be quite pervasive in the life of the sufferer, who may become perplexed and experience marked
disturbance of affect, drive, interest, memory and concentration. Suicide and homicide are significant
risks.
Because of their recurring nature and because of the pervasiveness of the disruptions, these conditions are
disqualifying for medical certification. The introduction of the newer anti-psychotic medicines, which
often lead to better medication compliance, have resulted in better outcome for the schizophrenias.
Nevertheless, the schizophrenic disorders remain incompatible with aviation safety.
Delusional Disorders may present without perceptual disturbances. Usually the delusions are relatively
restricted and may follow only one theme, such as delusions of infidelity. The risk associated with a
delusional disorder is that the person will act out behaviour to deal with the delusional belief without
consideration of the effect of such action or behaviour on others.
A Brief Psychotic Disorder may involve all the symptoms of schizophrenia, but it lasts less than one
month and is followed by a full return to the premorbid level of functioning. This disorder is usually
secondary to severe external stressors (“brief reactive psychosis”). If there is stability for at least one year
without the need for anti-psychotic medication, this disorder need not preclude medical certification.
ICAO Preliminary Unedited Version — October 2008 III-9-5
NEUROTIC, STRESS RELATED, AND SOMATOFORM DISORDERS
(DSM-IV Anxiety Disorders, Somatoform Disorders, Dissociative Disorders, Adjustment Disorders)
An aviation examiner must assess the degree to which any of the symptoms in this group of disorders will
impair a pilot’s alertness and his ability to evaluate sensory input, to concentrate on the task at hand, to
make decisions, and to execute those decisions with adequate cognitive and motor skill. Preoccupation
with symptoms, a sense of anxiety, and the impaired cognition associated with many of these disorders
would usually, at least temporarily, be disqualifying. Response to treatment, side effects of medications,
and the risk of recurrence of symptoms are determining factors in the evaluation.
Any mental disorder with anxiety is disqualifying until the person has been asymptomatic without the use
of psychotropic medicines for a period of at least six months. Since many of these disorders are of a
chronic nature, it is important that in a new applicant, the natural history of his disorder should be part of
the evaluation. Unless the disorder is likely to be resolved without long-term use of medication, an
aviation career should be discouraged.
Persons who have experienced psychiatric symptoms in response to external stressors (Adjustment
Disorders) should be assessed temporarily unfit but may be reassessed after a period of stability without
use of psychotropic medication. Persons who undergo lengthy periods of stress frequently use alcohol
and/or other psychoactive substances as a modifying agent. The medical examiner should always inquire
about such use.
DISORDERS OF PERSONALITY AND BEHAVIOUR
(DSM-IV Personality Disorders, Impulse Control Disorders, Paraphilias)
Personality disorders are deeply ingrained maladaptive patterns of behaviour, which are present during
the entire adult life of a person. These behavioural patterns may cause the person surprisingly little
discomfort but are usually a source of distress to others. Because of the maladaptive quality of these
personalities, they rarely fit well into society. They either marginalize themselves or are in various forms
of conflict with their environment.
Many people have styles of behaviour which are far from optimal, but these must be differentiated from
personality disorders, which are clearly maladaptive and may lead to conflict. People whose behavioural
patterns are less than optimal also usually recognize the problem and have the ability to make changes
that improve their situation.
It would be rare for a person with a personality disorder to have the emotional, intellectual and social
flexibility to be a good, safe and functional pilot or air traffic control officer. Except in rare
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Manual of Civil Aviation Medicine 2(15)
