The key consideration in this area is identical to other medical conditions, i.e. will the condition interfere with the safe conduct of the flight or will the flight environment exacerbate the condition?
With the modern management of many psychiatric conditions, air travel should not be a problem for the majority of individuals. It is however essential that the condition is stable and if medication is required it is taken regularly.
The main areas for concern are people whose behaviour may be unpredictable, aggressive, dis-organised or disruptive. In these circumstances, air travel would be contra-indicated. Patients with well-managed psychotic conditions may require an escort to ensure regular medication and to assist in case of problems. The escort may be a reliable companion or in more difficult cases, a qualified health professional. Taking a careful history eliciting, especially, details of previous disturbed or disorientated behaviour is particularly important.
Close liaison with the treating physician and the airline concerned is important and clearance to travel can be done either by telephone or by using the formal MEDIF form, which is available in Appendix E of the IATA Medical Manual.