Just heard that the copilot, Andreas Lubitz, on the Germanwings plane that crashed in the Alps suffered from Generalized Anxiety Disorder. But I’m also hearing about some sort of “psychotic episode” in 2010 and had anti-psychotic medications. Let’s talk about each of these issues separately.

First off, just what is “Generalized Anxiety Disorder”. In a nutshell, it means that a person is having anxiety that is triggered by any number of things. If he felt anxiety related to just one thing, say heights, he would have been diagnosed as having a Simple Phobia. The sufferer from GAD feels anxiety and worries about all sorts of things “such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties.^[2][3] Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, bouts of difficulty breathing, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, and rashes and inability to fully control the anxiety (Wikipedia). As you can see, there are a lot of physical type symptoms related to GAD. How this may or may not relate to the previously mentioned “psychosomatic illness” is unclear at this point. Should Lubitz have been flying with this problem? It depends on the severity of the symptoms and which ones he was having. Could he have concealed these problems? Possibly, though that probably would have only added to the stress and anxiety.

Next, let’s look at “psychotic episode.” This is not really a diagnosis, but is often part of a diagnosis of some sort of psychotic disorder. In essence, it involves either hallucinations or delusions or both. There are other symptoms often associated with the psychotic episode, but these vary. Is this schizophrenia? It could be, but it could be related to a wide variety of other disorders or causes. This statement about Lubitz having had a psychotic episode tells us only that he had a period of time when he was not really in touch with the reality most of us share. It could have been brief. It could have been a one-off situation, never to recur. It could have been related to medication or physical illness (some illnesses like measles or other infection with high fever can result in hallucinations). Again, as with so much in this case, we just don’t know yet.

Now to talk about the “antipsychotic medication”. These include medications like Haldol, Thorazine, Seroquel, Zyprexa and a slew of others. Drugs like Haldol and Thorazine are often called “typical” antipsychotics, while the others are called “atypical” and are the drugs of choice nowadays. I’d like to know when this medication was prescribed. Back in 2010 or more currently? I guess it could be possible that he had left-over meds from that psychotic episode in 2010. If he was currently on an antipsychotic medication (which I’ve seen used as a sleep aid in patients who were NOT psychotic), that’s a whole different story…...UPDATE: just heard that he was given antipsychotic injections back in 2010 and that antidepressants were found in his apartment.

Once again, we’re left with a lot of questions still about this tragic case. BTW: It’s been my experience that docs often prescribe antidepressant medications for GAD. Also, the FAA (don’t know about the regulations in Germany, any help here would be appreciated) announced it would consider waivers that would allow a pilot taking certain antidepressants to continue flying.

UPDATE 3/30/15:  I heard a report on CNN that back in the 2009/2010 time frame, Lubitz was given Zyprexa. This medication is an “atypical” antipsychotic medication in wide use. It has some serious side effects, including sedation, weight gain, visual problelms, muscle problems, and a whole lot more. On the other hand, it’s very effective for individuals suffering from hallucinations and delusions. No, he wouldn’t have been able to fly while taking this medication.