Travel Medicine Faculty Group, Internal Medicine Chair, Medical Faculty, Debrecen University, 1039 Debrecen, Hungary.
International Association for Medical Assistance to Travellers, Toronto, ON, ON M6K 3E3 Canada.
J Travel Med. 2020 Mar 13;27(2). doi: 10.1093/jtm/taaa013.
The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches.
Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems.
Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place.
Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.
旅行者在国外遭遇的精神障碍应该引起患者、家属和当地医疗保健专业人员的警惕。据估计，有 11.3%的旅行者会出现某种精神问题，其中 2.5%患有严重精神病，1.2%在从国外旅行返回后需要超过 2 个月的治疗。急性精神病发作约占与旅行相关的精神事件的五分之一。然而，与旅行相关的精神问题至今仍是一个被忽视的话题。现在有大量的文献可供选择，以帮助进一步的研究。
除了描述与旅行相关的精神障碍的最相关文献外，作者还介绍了处理国外旅行者精神问题的两个关键问题：确定精神障碍的起源和患者的处理过程。
由于语言障碍和特殊情况下的环境，识别旅行者精神症状的起源和性质往往很困难。一个简单的两步三分支算法可以使主治医生更容易做出决策。一些短暂的精神病和精神障碍的器质性原因可以在当地得到治疗。
一些精神问题可能源于旅行或外国环境本身，或者由其引发。在这些情况下，如果消除了诱发因素，就有望完全康复。解决方案是尽早遣返。因精神原因遣返与因其他医疗紧急情况遣返有很大不同。作者描述了一个精神病人遣返的逐步行动方案。通过这个建议的方案，可以成功地将患者带回家。
