According to the instructions, the astronaut's crewmates should bind his wrists and ankles with duct tape, tie him down with a bungee cord and inject him with tranquilizers if necessary.

    "Talk with the patient while you are restraining him," the instructions say. "Explain what you are doing, and that you are using a restraint to ensure that he is safe."

    The directions for dealing with a psychological emergency are included in a 1,051-page NASA document titled the International Space Station Integrated Medical Group Medical Checklist.

    The checklist, which was written in Russian and English, was compiled in 2000 and 2001 to coincide with the permanent staffing of the space station.

    A mentally unstable astronaut could cause all kinds of havoc that could endanger the three crew members aboard the space station or the six or seven who typically fly aboard the shuttle.

    The instructions do not spell out what happens after that. But NASA spokesman James Hartsfield said the space agency, a flight surgeon on the ground and the commander in space would decide on a case-by-case basis whether to abort the flight, in the case of the shuttle, or send the astronaut home, if the episode took place on the international space station.

    Space station medical kits contain tranquilizers and anti-depression, anti-anxiety and anti-psychotic medications. Shuttle medical kits have anti-psychotic medication but not antidepressants, since they take several weeks to be effective and shuttle flights last less than two weeks.

    The checklist says astronauts can be restrained and then offered oral Haldol, an anti-psychotic drug used to treat agitation and mania, and Valium. If the astronaut will not cooperate, the drugs can be forcibly given with a shot to the arm. Crew members are instructed to stay with the tied-up astronaut to monitor vital signs.

    Currently, astronauts are carefully tested and screened during the application process to eliminate those who are unstable. But unless they are bound for the space station for a monthslong stay in orbit, they are not put through any regular psychological tests after that.

    Astronauts selected for the space station get a psychiatric assessment six months and a month before launch.

    Nowak, who flew on a July shuttle mission, was placed on 30-day leave by the space agency after her arrest. Though released on bond, she also was removed by NASA from her duties as lead communications officer in Mission Control for the March flight of the shuttle Atlantis. 

(Agencies)