Travel-related psychosis (TrP): a landscape analysis.

Background: Travel-related psychosis (TrP) can be difficult for both the traveller and treating clinician. This review focuses upon a particular subset of TrP occurring during travel to destinations with high religious, spiritual, cultural or aesthetic value (high valence destinations) because it is both interesting and informative.

Method: Psychiatric, occupational and travel medicine literature was reviewed using PubMed with search terms of 'travel' AND 'psychosis' and 'international travel' AND 'psychosis' from 1998 to the present. Articles were included if they dealt with psychosis in travellers to high valence destinations. Articles were excluded if they dealt primarily with psychosis in travellers due to drug or medication usage. French literature was obtained using the CH St. Anne Ey Medical Library, Paris, France.

Results: Literature on TrP to high valence destinations is lacking many details. The range of high valence destinations is wide. Incidence and prevalence figures for TrP of any type do not exist although rough calculations as to incidence of psychiatric problems and psychosis in travellers are made based upon the articles reviewed and are discussed. Findings lead to several hypotheses with both medico-legal, diagnostic and epidemiological ramifications.

Conclusions: TrP to a number of high valence destinations is a real phenomenon worthy of further study. It is not clear that TrP is more likely to occur with such travel than to non-high valence destinations or not. First episode psychosis during travel to high valence and other destinations is reported and has medico-legal ramifications. Some TrP episodes likely are brief psychotic disorders and this hypothesis should be rigorously explored in future reports. A number of suggestions concerning further studies are made.