Abstract
To the Editor
Overseas travel can potentially trigger a relapse of psychotic disorders. One of the major contributing factors is jet lag syndrome, which appears after multiple time zone transitions as body rhythms shift out of phase with the local environment (Katz, 2011). Changes to medication times, dehydration, disruption to usual activities, confinement in a small aeroplane cabin seat for many hours and possible changes to biochemistry can also contribute to psychiatric complications.
The aim of this letter is to highlight simple measures patients should be aware of in order to help prevent relapse of their illness while travelling. The following case highlights the importance of patient education.
Mrs A is a 39-year-old female with schizoaffective disorder, well managed on sodium valproate and quetiapine. She was admitted to a psychiatric ward with mania and psychosis after a recent holiday overseas.
The holiday involved multiple flights over long distances. On arrival at the overseas country Mrs A’s mood was elevated and she had a decreased need for sleep; as a result, following discussion with her psychiatrist, her quetiapine dose was increased. This resolved the problem and while on holiday there were no other symptoms. On return to Australia Mrs A became increasingly manic. She checked into a hotel by herself for 3 days, ceased her medications and required minimal sleep; as a result she was admitted to a psychiatry inpatient unit. She was agitated, verbally abusive, highly disorganised and unable to follow direction. Mrs A required 10 days of treatment to recover, which caused significant problems for her and her family.
Even though the current literature concerning jet lag triggering psychosis is inconsistent, evidence suggests it may yield an exacerbation of existing psychotic conditions (Katz, 2011).
Suggestions to minimise dramatic disruptions to body rhythms:
Patients should plan medication timing well ahead of travel in consultation with their doctor.
Subtly alter sleeping and eating patterns before leaving. During the flight it is vital for patients to set their watch to the time of their destination and use watch alarms to take medications according to the destination time zone. Airlines serve food according to the destination time, which assists in shifting time zones.
Maintain reasonable hydration as the dry cabin air can contribute to dehydration (Herxheimer and Waterhouse, 2003). This can be particularly problematic for patients taking lithium.
On arrival, do not schedule many activities. A brief nap may be useful – but this should not be greater than 30 minutes if during the day (Herxheimer and Waterhouse, 2003).
Although research is ongoing, the use of scheduled exposure to some form of artificial light will in future be the optimal method for entraining the circadian clock before and after aeroplane travel (Forbes-Robertson et al., 2012).
There are some data supporting the ability of melatonin to reduce the symptoms of jet lag and improve sleep (Katz, 2011). However, information about the interaction of melatonin and psychotropic medication is limited.
Footnotes
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.