Can High Altitude Exacerbate a Remittent Alcohol Use Disorder in a Patient With a History of Panic Attacks?

Background: Several studies have already investigated the brief and long-term neurological effects of exposure to high altitudes and the related sequelae of hypoxia on memory and cognition, but few authors have discussed the question of psychic symptoms during high-altitude activities. These authors suspect that the reexacerbation or worsening of psychiatric symptoms may well be the expression of maladaptive behaviors in response to changes in environmental conditions. Case Report: We describe the case of a patient with a history of sporadic Panic Attacks with elements of the panicagoraphobic spectrum (social phobia and separation anxiety) who, in a specific social context during adolescence, tended to misuse alcohol for recreational and disinhibitory purposes to solve his relational problems in the social sphere. After many years of abstinence, this patient decided to accept exposure to high altitudes at work and developed a serious alcohol use disorder, including the progressive worsening of his functioning in the social and working dimensions. Discussion: We propose that, because of the daily experiencing of high altitudes at work, the patient’s anxiety levels rose sharply, but unconsciously and automatically, according to a mode of copying previously enacted in adolescence (through social phobia and the use of alcohol to become disinhibited); he also implemented binge drinking behaviors for self-medicative and antianxiety purposes, which gradually triggered a mechanism of alcohol dependence.