Development of a questionnaire to detect high-altitude psychosis: the HAPSY questionnaire
Brodmann Maeder M
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SubjectDelphi process; HACE; High altitude; Positive symptoms of psychosis; Psychosis; Self-rating questionnaire
Psychotic episodes during exposure to very high or extreme altitude have been related to accidents or near accidents in the mountains. It is thus of great importance to identify individuals with psychotic symptoms quickly and reliably directly on the mountain even in the absence of experienced medical personnel. Psychotic episodes are characterized by symptoms such as hallucinations (e.g., seeing people who are not really there, feeling the presence of another being who is not really present), delusions, disorganized thinking/speech, or abnormal psychomotor behavior. The aim of this study was to develop a questionnaire (HAPSY questionnaire) to assess psychotic symptoms through a self-rating directly on the mountain. We used two existing self-rating questionnaires for psychotic symptoms (the psychotomimetic states inventory and the Cardiff Anomoulous Perception Scale) as a basis for a two-round Delphi process. Additional statements were proposed by the Delphi participants. The Delphi experts were 14 climbers, who had previously experienced psychosis at altitude, and 26 psychiatrists with expertise in psychosis research and/or treatment. Through the Delphi process, eleven questions – all of them related to perceptual distortion – were finally identified to be most useful for the detection of psychotic symptoms at altitude via self-rating. The next step will be to validate the HAPSY questionnaire in a field study, where the self-ratings will be compared with physicians’ ratings.
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