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Koskinen J, Hakko H, Riipinen P, Sihvola N, Halt AH. A letter to the editor: The impact of comorbid depression and substance use disorder on drivers with a psychotic disorder killed in motor vehicle accidents. Schizophr Res 2024; 270:246-248. [PMID: 38943927 DOI: 10.1016/j.schres.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 04/29/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Affiliation(s)
- Jussi Koskinen
- University of Oulu, Research Unit of Clinical Medicine, Psychiatry, P.O.Box 5000, FI-90014 Oulu, Finland.
| | - Helinä Hakko
- University of Oulu, Research Unit of Population Health, Oulu, Finland; Oulu University Hospital, Psychiatry, Oulu, Finland.
| | - Pirkko Riipinen
- University of Oulu, Research Unit of Clinical Medicine, Psychiatry, P.O.Box 5000, FI-90014 Oulu, Finland; Oulu University Hospital, Psychiatry, Oulu, Finland.
| | - Niina Sihvola
- Finnish Crash Data Institute (OTI), Itämerenkatu 11-13, FI-00180 Helsinki, Finland.
| | - Anu-Helmi Halt
- University of Oulu, Research Unit of Clinical Medicine, Psychiatry, P.O.Box 5000, FI-90014 Oulu, Finland; Oulu University Hospital and University of Oulu, Medical Research Center, Oulu, Finland; Oulu University Hospital, Psychiatry, Oulu, Finland.
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Staples JA, Daly-Grafstein D, Khan M, Pei LX, Erdelyi S, Rezansoff SN, Chan H, Honer WG, Brubacher JR. Schizophrenia, antipsychotic treatment adherence and driver responsibility for motor vehicle crash: a population-based retrospective study in British Columbia, Canada. BMJ Open 2024; 14:e080609. [PMID: 39079929 PMCID: PMC11293420 DOI: 10.1136/bmjopen-2023-080609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 07/03/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE To examine the relationship between schizophrenia, antipsychotic medication adherence and driver responsibility for motor vehicle crash. DESIGN Retrospective observational cohort study using 20 years of population-based administrative health and driving data. SETTING British Columbia, Canada. PARTICIPANTS Licensed drivers who were involved in a police-attended motor vehicle crash in British Columbia over a 17-year study interval (2000-16). EXPOSURES Incident schizophrenia was identified using hospitalisation and physician services data. Antipsychotic adherence was estimated using prescription fill data to calculate the 'medication possession ratio' (MPR) in the 30 days prior to crash. PRIMARY OUTCOME MEASURES We deemed drivers 'responsible' or 'non-responsible' for their crash by applying a validated scoring tool to police-reported crash data. We used logistic regression to evaluate the association between crash responsibility and exposures of interest. RESULTS Our cohort included 808 432 drivers involved in a police-attended crash and for whom crash responsibility could be established. In total, 1689 of the 2551 drivers with schizophrenia and 432 430 of the 805 881 drivers without schizophrenia were deemed responsible for their crash, corresponding to a significant association between schizophrenia and crash responsibility (66.2% vs 53.7%; adjusted OR (aOR), 1.67; 95% CI, 1.53 to 1.82; p<0.001). The magnitude of this association was modest relative to established crash risk factors (eg, learner license, age ≥65 years, impairment at time of crash). Among the 1833 drivers with schizophrenia, near-optimal antipsychotic adherence (MPR ≥0.8) in the 30 days prior to crash was not associated with lower crash responsibility (aOR, 1.04; 95% CI, 0.83 to 1.30; p=0.55). CONCLUSIONS Crash-involved drivers with schizophrenia are more likely to be responsible for their crash, but the magnitude of risk is similar to socially acceptable risk factors such as older age or possession of a learner license. Contemporary driving restrictions for individuals with schizophrenia appear to adequately mitigate road risks, suggesting more stringent driving restrictions are not warranted.
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Affiliation(s)
- John A Staples
- Division of General Internal Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Daniel Daly-Grafstein
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lulu X Pei
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Herbert Chan
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Okada H, Morimoto T, Ikeda N. Exploratory` study on driving ability of people with schizophrenia: Relationships among cognitive function, symptoms, and brain activity. Schizophr Res 2024; 264:290-297. [PMID: 38211373 DOI: 10.1016/j.schres.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/03/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND This study aimed to examine the relationships among cognitive function, symptoms, prefrontal activation, basic driving skills, and collision risk factors using a hazard prediction task in simulated driving. METHODS Participants included 42 people with schizophrenia aged 20-50 years who had actual experience of driving. The Trail making test (TMT) A and TMTB, Wechsler Memory Test-Revised (WMS-R), and Zoo Map test (ZMT) were used to evaluate cognitive function. Positive and negative syndrome scale was used to assess symptoms, and brain activity was assessed by evaluating cerebral blood flow during a visual working memory task using functional near-infrared spectroscopy. Driving tasks that tested basic skills, such as brake reaction, steering wheel skills, and standard deviation of lateral position, were analyzed using multiple regression analysis. Three hazard prediction tasks were performed using discriminant analysis. RESULTS Brake reaction associated with cerebral blood flow and TMT-A. Steering wheel skills associated with WMS-R, driving experience and depression. Significant differences were found between the collision and noncollision groups in the hazard prediction task, as shown by the ZMT, driving experience, and brake reaction. CONCLUSIONS Brain activity in the frontal lobe during a desk task may be useful data for driving assessment. Assessment of processing speed and learning ability may be particularly important in the evaluation of basic skills for safe driving. In addition, for people with schizophrenia, foresight, as represented by proactive planning, experience, and quick braking may be an essential characteristic to anticipate danger and react quickly enough to avoid collisions.
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Affiliation(s)
- Hiroki Okada
- Department of Rehabilitation of Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
| | - Takafumi Morimoto
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Japan
| | - Nozomu Ikeda
- Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Japan
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Biedermann F, Kurzthaler I, Haibach M, Pardeller S, Pichler T, Kemmler G, Holzner B, Hofer A. Driving fitness in clinically stable outpatients with chronic schizophrenia. Compr Psychiatry 2022; 118:152340. [PMID: 35868158 DOI: 10.1016/j.comppsych.2022.152340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Driving motorized vehicles is an integral part of individual mobility and a key parameter for employment and social integration. This naturalistic, cross-sectional study investigated the associations between driving fitness, residual symptomatology, olanzapine equivalent, and extrapyramidal symptoms (EPS) in long term stable outpatients with schizophrenia. METHODS Beside sociodemographic data, and driving habits, residual symptoms, and EPS were assessed using the Positive and Negative Syndrome Scale (PANSS), and the Modified Simpson Angus Scale (MSAS). PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. MSAS cut-off scores ≥3 were defined as positive for EPS. Driving skills were assessed using the Vienna Test System and an expert evaluation. RESULTS 50 patients were included into the study. Mean PANSS total scores indicated mild residual symptomatology and EPS were not present in 48% of study participants. 44% passed the driving fitness assessment and were considered as competent to drive, 20% were judged to be partially competent and 36% to be incompetent to drive. With the exception of disorganization (r = -0·287, p = 0·048) residual symptoms of schizophrenia did not correlate with driving fitness. However, moderate negative correlations were detected between driving fitness and the severity of EPS (r = -0·554, p = 0·000), age (r = -0·413, p = 0·003) as well as olanzapine equivalent doses (r = -0·432, p = 0·002). These results were not corrected for multiple comparison. DISCUSSION The present findings indicate that up to two thirds of clinically stable outpatients with chronic schizophrenia may be (partially) competent to drive. Both the presence of EPS as well as the dosage of antipsychotic medication seem to be of particular relevance in this regard.
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Affiliation(s)
- Falko Biedermann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria.
| | - Ilsemarie Kurzthaler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Maria Haibach
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Theresia Pichler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Bernhard Holzner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
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Brunnauer A, Herpich F, Zwanzger P, Laux G. Driving Performance Under Treatment of Most Frequently Prescribed Drugs for Mental Disorders: A Systematic Review of Patient Studies. Int J Neuropsychopharmacol 2021; 24:679-693. [PMID: 34038545 PMCID: PMC8453274 DOI: 10.1093/ijnp/pyab031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mobility is important for daily life functioning, with particular challenges regarding road safety under pharmacological treatment in patients with a psychiatric disease. METHODS According to PRISMA guidelines, a systematic literature search on PubMed database (January 1970 to December 2020) was performed. Primary endpoints were driving performance in on-road tests, driving simulator performance, or psychomotor and visual perception functions assessed to estimate fitness to drive according to legal regulations in patient studies. RESULTS Forty studies were identified (1533 patients, 38% female, median age 45 years), of which more than 60% were cross-sectional and open-label trials. Under steady-state medication, 31% (range 27%-42.5%) of schizophrenic or schizoaffective patients under antipsychotics and 18% (range 16%-20%) of unipolar and bipolar patients under antidepressants showed severe impairment in skills relevant for driving. Data point to an advantage of second-generation antipsychotics compared with first-generation antipsychotics as well as modern antidepressants over tricyclic antidepressants with respect to driving. Most patients significantly improved or stabilized in driving skills within 2-4 weeks of treatment with non-sedative or sedative antidepressants. Diazepam significantly worsened driving the first 3 weeks after treatment initiation, whereas medazepam (low dose), temazepam, and zolpidem did not impair driving. In long-term users of sedating antidepressants or benzodiazepines, impairments in on-road tests were not evident. CONCLUSION The available evidence suggests that psychopharmacologic medicines improve or at least stabilize driving performance of patients under long-term treatment when given on clinical considerations. To enhance treatment compliance, existing classification systems of medicinal drugs concerning impact on driving performance should also incorporate information about effects of long-term-treatment.
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Affiliation(s)
- Alexander Brunnauer
- kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg/Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
- Correspondence: Alexander Brunnauer, PhD, kbo-Inn-Salzach Klinikum, Department of Neuropsychology, D-83512 Wasserburg/Inn, Germany ()
| | - Florian Herpich
- kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg/Inn, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg/Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
- Institute of Psychological Medicine (IPM) Soyen, Germany
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Noh S, Na E, Park SJ, Kim SH, Evins AE, Roh S. Effects of various antipsychotics on driving-related cognitive performance in adults with schizophrenia. J Psychiatr Res 2020; 131:152-159. [PMID: 32971359 DOI: 10.1016/j.jpsychires.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/13/2023]
Abstract
The aim of this study was to determine whether the driving-related cognitive performance differs among adults with schizophrenia taking different types of antipsychotics. Neurocognitive performance was assessed using the Cognitive Perceptual Assessment for Driving (CPAD), a computerized battery of tests of visual perception, attention, working memory, reaction time, and inhibitory control for driving ability. One hundred and two adults with schizophrenia who were on antipsychotic monotherapy participated in the study. Of these, 15 were on haloperidol, 28 on risperidone, 14 on olanzapine, 28 on aripiprazole, and 17 on paliperidone. Sixty-four (63%) of the 102 subjects were regarded as competent to drive. Of the subjects taking haloperidol, 33% passed the CPAD, while the passing rates of subjects taking risperidone, olanzapine, aripiprazole, and paliperidone were 57%, 57%, 75%, and 82%, respectively, with a significant difference between the haloperidol and aripiprazole groups (p = 0.005) and between the haloperidol and paliperidone groups (p = 0.001). Additionally, scores on CPAD depth perception (number of correct responses), divided attention, digit span test, and trail-making test B subtests were significantly better for the aripiprazole and paliperidone groups than for the haloperidol and risperidone groups. In this cross-sectional design study, adults with schizophrenia treated with aripiprazole or paliperidone antipsychotic monotherapy demonstrated superior driving-related cognitive performance than those treated with haloperidol or risperidone antipsychotic monotherapy.
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Affiliation(s)
- Seokmin Noh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea
| | - Euihyeon Na
- Department of Neuropsychiatry, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Se Jin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - A Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea; Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Hill LL, Andrews H, Li G, DiGuiseppi CG, Betz ME, Strogatz D, Pepa P, Eby DW, Merle D, Kelley-Baker T, Jones V, Pitts S. Medication use and driving patterns in older drivers: preliminary findings from the LongROAD study. Inj Epidemiol 2020; 7:38. [PMID: 32741358 PMCID: PMC7397667 DOI: 10.1186/s40621-020-00265-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. Methods Data for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65–79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the “brown-bag review” method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants’ main vehicles. Results Medication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0–51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio). Conclusions Older adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults.
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Affiliation(s)
- Linda L Hill
- Department of Family Medicine and Public Health, University of California, 200 W Arbor Dr., MC 0811, San Diego, CA, 92103, USA.
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 1051 Riverside Dr. Unit 47, New York, NY, 10032, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St. Rm 524, New York, NY, 10032, USA.,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 W 168th St. Rm 524, New York, NY, 10032, USA.,Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 722 W 168th St. Rm 524, New York, NY, 10032, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Bldg. 500, Rm. W3138, Aurora, CO, 80045, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Leprino Building, Campus Box B215, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, 1 Atwell Rd, Cooperstown, NY, 13326, USA
| | - Patricia Pepa
- Department of Ambulatory Care Clinical Pharmacy, Kaiser Permanente, Oakland, USA
| | - David W Eby
- Transportation Research Institute, University of Michigan, 2901 Baxter Rd, Ann Arbor, MI, 48109, USA
| | - David Merle
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 1051 Riverside Dr. Unit 47, New York, NY, 10032, USA
| | - Tara Kelley-Baker
- AAA Foundation for Traffic Safety, 607 14th St. NW, Ste. 201, Washington, DC, 20005, USA
| | - Vanya Jones
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Samantha Pitts
- Department of Medicine, School of Medicine, Johns Hopkins University, 733 North Broadway, Baltimore, MD, 21205, USA
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Li L, Li L, Shang DW, Wen YG, Ning YP. A systematic review and combined meta-analysis of concentration of oral amisulpride. Br J Clin Pharmacol 2020; 86:668-678. [PMID: 32090363 DOI: 10.1111/bcp.14246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/12/2020] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS Amisulpride, a first-line schizophrenia treatment, has shown large interindividual variability in plasma/serum levels, often outside the reference range (100-320 ng/mL). This study aims to clarify the impact of dose, sex, age and related factors for the interpatient variability in amisulpride plasma/serum concentration. METHODS Both English and Chinese databases were searched from their inception to May 16, 2019, using the terms: amisulpride and (plasma OR serum OR blood OR "drug monitoring" OR concentration). Studies reporting concentrations and either a dose, associated factor, clinical outcome or side effect were included. RESULTS Fourteen studies with 1628 participants were eventually included. Eligible articles yielded data on drug concentration and dose, averaging 333.9 (95% confidence interval [CI]: 294.5-373.3) ng/mL and 636.2 (95% CI: 549.7-722.6) mg/d, respectively. The calculated mean concentration-to-dose (C/D) ratio was 0.60 (95% CI: 0.52-0.67) (ng/mL)/mg. Subgroup analysis suggested that female patients on combined lithium-amisulpride have higher concentration levels and C/D ratios. Age was slight positive associated with C/D ratio while not for plasma level. Smoker patients have high concentration level than nonsmoking patients but not for C/D. Responsive and nonresponsive groups did not differ in concentration and C/D. CONCLUSION Pooled concentration levels of amisulpride were higher than recommended with wide individual variation, especially in older patients, female patients and patients taking amisulpride combined with lithium. The specific therapeutic reference range for amisulpride may require reconstruction, which should consider the influence of age, sex, kidney function, drug-drug interactions, different dose regimens and sampling times in future study.
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Affiliation(s)
- Lin Li
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - De-Wei Shang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Guan Wen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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A short survival time after last psychiatric hospitalization in drivers with psychotic disorder killed in fatal motor vehicle accidents. Schizophr Res 2020; 216:235-242. [PMID: 31813802 DOI: 10.1016/j.schres.2019.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/20/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Research-based evidence on patients with psychotic disorders involved in fatal motor vehicle accidents (FMVA) remains limited. The current study analyzes the characteristics of FMVA drivers, who had been hospitalized due to psychotic disorders within a five-year-time-period prior to their death in traffic accidents. MATERIAL AND METHODS Data sources included three national registers: The Finnish Database of Road and Cross-Country Accidents, the Care Register for Health Care and the National Cause of Death Register. The register-linkage was made using personal identity codes, unique for each Finnish citizen. The initial study population consisted of 4930 drivers killed in FMVA in Finland between the years 1990-2011. A total of 94 (1.9%) Finnish drivers had a hospital-diagnosed psychotic disorder made during the five years preceding their FMVA. The psychotic disorders of the study subjects were categorized into: schizophrenia (n = 27, 28.7%), other specified psychoses (n = 39, 41.5%) and unspecified psychoses (n = 28, 29.8%). RESULTS About one half of the FMVA drivers with schizophrenia or unspecified psychoses and 41% of those with other specified psychoses had been discharged from psychiatric care within three months prior to their death in traffic accidents. CONCLUSIONS Based on our study findings and the lack of concise guidelines for assessing psychotic patients' fitness-to-drive, we recommend a minimum temporary driving restriction of three months for all patients after hospitalization for psychosis.
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Antipsychotics in the general population and the driver population: comparisons from a population-based registry study. Int Clin Psychopharmacol 2019; 34:184-188. [PMID: 30998595 DOI: 10.1097/yic.0000000000000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antipsychotics are considered driving-impairing medicines. A population-based registry study design was conceived to assess the year-2016 antipsychotic dispensation in Castile and León, Spain. Weighting was performed to obtain the adjusted antipsychotic consumption for licensed drivers according to age and gender using the Spanish national drivers' license census data. In 2016, antipsychotics were dispensed to 3.86% of the general population and 2.71% of licensed drivers. Antipsychotic use was higher in females (4.72%) than in males (2.98%), and increased as age increased, but women drivers used less antipsychotics after 60 years old. Chronic antipsychotic use (≥30 days) accounted for 1.62%. Typical antipsychotics predominated among acute users (1.60% versus 0.09%), while atypical antipsychotics were the rule in chronic use (1.41% versus 0.36%). A concomitant use of antipsychotics with other driving-impairing medicines was also common. This study is intended for updating the epidemiological knowledge of all involved in the control of use of antipsychotics and other driving-impairing medicines (healthcare providers, patients, authorities, and drug developers) in order to improve prescribing/dispensing and a well tolerated use of all driving-impairing medicines by the population. Awareness is needed to improve safety on driving, and there is a need worldwide to improve interventions in the field of medicines and driving.
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Hellinger N, Lipskaya-Velikovsky L, Weizman A, Ratzon NZ. Comparing executive functioning and clinical and sociodemographic characteristics of people with schizophrenia who hold a driver's license to those who do not. The Canadian Journal of Occupational Therapy 2019; 86:70-80. [PMID: 30991831 DOI: 10.1177/0008417419831399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Community engagement requires driving. However, there is paucity of research focusing on the potential to drive for people with schizophrenia. PURPOSE. This study aimed to characterize people with schizophrenia by comparing clinical signs, executive functions (EF), and sociodemographic aspects of those holding a driver's license to those without one. METHOD. This cross-sectional study used convenience sampling to select 60 ambulatory individuals to participate: 31 with a driver's license and 29 without one. They completed the Wisconsin Card Sorting Test (WCST) for evaluation of EF and the Positive and Negative Syndrome Scale (PANSS) for symptoms severity evaluation. Data were analyzed using multivariate analyses of covariance and logistic regression models. FINDINGS. Participants with a license had less severe negative symptoms and general psychopathology and better EF and sociodemographic aspects compared to those without a license. Logistic regression revealed significant odds ratios (OR) in general psychopathology (PANSS; OR = 0.963, p = .011) and in the WCST (OR = 0.504, p = .027). IMPLICATIONS. This study offers occupational therapists a data-driven perspective on evaluating potential fitness to drive to enable participation in daily life and well-being of people with schizophrenia.
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Iwata M, Iwamoto K, Kawano N, Kawaue T, Ozaki N. Evaluation method regarding the effect of psychotropic drugs on driving performance: A literature review. Psychiatry Clin Neurosci 2018; 72:747-773. [PMID: 29962103 DOI: 10.1111/pcn.12734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/31/2022]
Abstract
Although automobile driving is necessary for many people, including patients with mental disorders, the influence of psychotropic drugs on driving performance remains unclear and requires scientific verification. Therefore, the objective of this study was to conduct a review of the literature in order to aid the development of a valid evaluation method regarding the influence of medication on driving performance. We conducted a literature search using two sets of terms on PubMed. One set was related to psychotropic drugs, and the other to driving tests. We excluded reviews and case studies and added literature found on other sites. A total of 121 relevant reports were found. The experiments were roughly divided into on-the-road tests (ORT) and driving simulators (DS). Although highway driving tests in ORT are most often used to evaluate driving performance, DS are becoming increasingly common because of their safety and low cost. The validity of evaluation methods for alcohol should be verified; however, we found that there were few validated tests, especially for DS. The scenarios and measurement indices of each DS were different, which makes it difficult to compare the results of DS studies directly. No evaluation indices, except for SD of lateral position, were sufficiently validated. Although highway ORT are the gold standard, DS were shown to have an increasing role in evaluating driving performance. The reliability of DS needs to be established, as does their validation with alcohol in order to accumulate more high-quality evidence.
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Affiliation(s)
- Mari Iwata
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Naoko Kawano
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan.,Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
| | - Takumi Kawaue
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
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Segmiller FM, Buschert V, Laux G, Nedopil N, Palm U, Furjanic K, Zwanzger P, Brunnauer A. Driving skills in unmedicated first- and recurrent-episode schizophrenic patients. Eur Arch Psychiatry Clin Neurosci 2017; 267:83-88. [PMID: 26499939 DOI: 10.1007/s00406-015-0647-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/12/2015] [Indexed: 12/26/2022]
Abstract
The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58 %) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38 %) showing severe impairments when compared with RES (25 %). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness.
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Affiliation(s)
- Felix M Segmiller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Verena Buschert
- Department of Neuropsychology, Psychiatric Clinic, kbo Inn-Salzach-Klinikum, 83512, Wasserburg/Inn, Germany
| | - Gerd Laux
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.,Institute for Psychological Medicine (IPM), Haag i. OB, Germany
| | - N Nedopil
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Furjanic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.,Department of Neuropsychology, Psychiatric Clinic, kbo Inn-Salzach-Klinikum, 83512, Wasserburg/Inn, Germany
| | - Alexander Brunnauer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.,Department of Neuropsychology, Psychiatric Clinic, kbo Inn-Salzach-Klinikum, 83512, Wasserburg/Inn, Germany.,Institute for Psychological Medicine (IPM), Haag i. OB, Germany
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Brunnauer A, Buschert V, Segmiller F, Zwick S, Bufler J, Schmauss M, Messer T, Möller HJ, Frommberger U, Bartl H, Steinberg R, Laux G. Mobility behaviour and driving status of patients with mental disorders - an exploratory study. Int J Psychiatry Clin Pract 2016; 20:40-6. [PMID: 26442635 DOI: 10.3109/13651501.2015.1089293] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. METHOD Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. RESULTS 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. CONCLUSION Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.
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Affiliation(s)
- Alexander Brunnauer
- a kbo-Inn-Salzach-Klinikum, Psychiatric Hospital , Department of Neuropsychology , Wasserburg/Inn , Germany ;,e Department of Psychiatry and Psychotherapy at the Ludwig-Maximilians University , Munich , Germany ;,i Institute for Psychological Medicine (IPM) , Haag i. OB , Germany
| | - Verena Buschert
- a kbo-Inn-Salzach-Klinikum, Psychiatric Hospital , Department of Neuropsychology , Wasserburg/Inn , Germany
| | - Felix Segmiller
- e Department of Psychiatry and Psychotherapy at the Ludwig-Maximilians University , Munich , Germany
| | - Sarah Zwick
- a kbo-Inn-Salzach-Klinikum, Psychiatric Hospital , Department of Neuropsychology , Wasserburg/Inn , Germany ;,f Vitos Klinik , Department of Forensic Psychiatry , Haina , Germany
| | - Johannes Bufler
- b kbo-Inn-Salzach-Klinikum, Psychiatric Hospital , Department of Neurology , Wasserburg/Inn , Germany
| | - Max Schmauss
- c Bezirkskrankenhaus Augsburg, Psychiatric Hospital , Augsburg , Germany
| | - Thomas Messer
- c Bezirkskrankenhaus Augsburg, Psychiatric Hospital , Augsburg , Germany ;,d Danuvius Klinik Pfaffenhofen, Psychiatric Hospital , Pfaffenhofen , Germany
| | - Hans-Jürgen Möller
- e Department of Psychiatry and Psychotherapy at the Ludwig-Maximilians University , Munich , Germany
| | - Ulrich Frommberger
- g Mediclin Klinik an der Lindenhöhe, Psychiatric Hospital , Offenburg , Germany
| | - Helga Bartl
- a kbo-Inn-Salzach-Klinikum, Psychiatric Hospital , Department of Neuropsychology , Wasserburg/Inn , Germany
| | - Reinhard Steinberg
- h Pfalzklinikum Klingenmünster, Psychiatric Hospital , Klingenmünster , Germany
| | - Gerd Laux
- e Department of Psychiatry and Psychotherapy at the Ludwig-Maximilians University , Munich , Germany ;,i Institute for Psychological Medicine (IPM) , Haag i. OB , Germany
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Steinert T, Veit F, Schmid P, Jacob Snellgrove B, Borbé R. Participating in mobility: People with schizophrenia driving motorized vehicles. Psychiatry Res 2015; 228:719-23. [PMID: 26089017 DOI: 10.1016/j.psychres.2015.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Participation of people with schizophrenia in individual mobility is an important aspect of inclusion according to the UN convention of human rights of persons with disabilities. However, driving motorized vehicles can be dangerous due to positive, negative, and cognitive symptoms, side effects of antipsychotic drugs and concomitant substance abuse. The objective of this study was to explore the patterns of individual mobility in a representative patient population, to determine predictors for active use of motorized vehicles, and to compare the results with data of the general population in the respective region. We interviewed N=150 participants with schizophrenia or schizoaffective disorder, 66 in-patients and 84 out-patients, in different types of out-patient services. A questionnaire developed for this purpose was used in interviews. 64% of the participants had a driving licence, 32% had driven a motorized vehicle in the past year, 31% owned a car, 2% a motor bike. The driving licence had been withdrawn from 24.7% of participants, 32.7% reported having been involved in a road accident. Participants drove considerably less in time and distances than the general population. Significant variables determining the chance of active use of motorized vehicles in a logistic regression model were Global Assessment of Functioning (GAF) (OR 1.04 per each point), number of previous admissions (OR 0.52 per admission), and history of driving under alcohol or drugs (OR 0.18).
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Affiliation(s)
- Tilman Steinert
- Centres for Psychiatry Suedwuerttemberg Weingartshofer Street 2, 88214 Ravensburg, Weissenau, Germany.
| | - Fabian Veit
- Centres for Psychiatry Suedwuerttemberg Weingartshofer Street 2, 88214 Ravensburg, Weissenau, Germany
| | - Peter Schmid
- Centres for Psychiatry Suedwuerttemberg Weingartshofer Street 2, 88214 Ravensburg, Weissenau, Germany
| | - Brendan Jacob Snellgrove
- Centres for Psychiatry Suedwuerttemberg Weingartshofer Street 2, 88214 Ravensburg, Weissenau, Germany
| | - Raoul Borbé
- Centres for Psychiatry Suedwuerttemberg Weingartshofer Street 2, 88214 Ravensburg, Weissenau, Germany
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16
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[Driving ability with affective disorders and under psychotropic drugs]. DER NERVENARZT 2014; 85:822-8. [PMID: 24906535 DOI: 10.1007/s00115-013-3994-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are only few data available regarding the effects of depressive disorders on road safety due to methodological shortcomings. Patients with acute severe depression or manias are unqualified for driving but after clinical remission driving ability can be attested under psychiatric supervision in most cases. So far there are only few data available about a patient's fitness to drive under psychotropic medication. Regarding the effects of antidepressants on road safety depressed patients obviously benefit from treatment with newer antidepressants; however, at least some subgroups of patients do not reach the performance level of healthy subjects. Approximately 17 % of remission bipolar patients must be regarded as unable to drive and 27 % of patients with schizophrenia on discharge from hospital. Benzodiazepines are clearly associated with increased risk of road traffic accidents. Impaired driving ability of young attention deficit hyperactivity disorder (ADHS) patients is improved under treatment with methylphenidate. Counselling patients with respect to driving ability must be carried out individually taking into account factors of the illness, personality, attitudes and coping strategies as well as different psychopharmacological effects.
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Fahrtauglichkeit bei Abhängigkeitserkrankungen und Schizophrenie. DER NERVENARZT 2014; 85:816-21. [DOI: 10.1007/s00115-013-3993-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Chang CM, Wu ECH, Chen CY, Wu KY, Liang HY, Chau YL, Wu CS, Lin KM, Tsai HJ. Psychotropic drugs and risk of motor vehicle accidents: a population-based case-control study. Br J Clin Pharmacol 2013; 75:1125-33. [PMID: 22971090 DOI: 10.1111/j.1365-2125.2012.04410.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/25/2012] [Indexed: 11/29/2022] Open
Abstract
AIM To examine comprehensively the relationship between exposure to four classes of psychotropic drugs including antipsychotics, antidepressants, benzodiazepines (BZDs) and Z-drugs, and motor vehicle accidents (MVAs). METHOD The authors conducted a matched case-control study of 5183 subjects with MVAs and 31 093 matched controls, identified from the claims records of outpatient service visits during the period from 2000 to 2009. Inclusion criteria were defined as subjects aged equal to or more than 18 years and involved in MVAs. Conditional logistic regressions with covariates adjustment (including urbanity, psychiatric and non-psychiatric outpatient visits and Charlson comorbidity score) were applied to examine the effect of four classes of psychotropic drugs on MVAs. RESULTS Significant increased risk of MVAs was found in subjects taking antidepressants within 1 month (adjusted odds ratio (AOR) 1.73, 95% confidence interval (CI) 1.34, 2.22), 1 week (AOR 1.71, 95% CI 1.29, 2.26), and 1 day (AOR 1.70, 95% CI 1.26, 2.29) before MVAs occurred. Similar results were observed in subjects taking benzodiazepines (BZDs) (AOR 1.56, 95% CI 1.38, 1.75 for 1 month; AOR 1.64, 95% CI 1.43, 1.88 for 1 week, and AOR 1.62, 95% CI 1.39, 1.88 for 1 day) and Z-drugs (AOR 1.42, 95% CI 1.14, 1.76 for 1 month, AOR 1.37, 95% CI 1.06, 1.75 for 1 week, AOR 1.34, 95% CI 1.03, 1.75 for 1 day), but not antipsychotics. Moreover, significant dose effects of antidepressants (equal to or more than 0.6-1.0 DDD), BZDs (equal to or more than 0.1-0.5 DDD) and Z-drugs (more than 1 DDD) were observed, respectively, on the risk of experiencing an MVA. CONCLUSION Taken together, subjects taking antidepressants, BZDs and Z-drugs, separately, should be particularly cautioned for their increasing risk of MVAs.
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Affiliation(s)
- Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital, Lin-Kou & Chang Gung University, Taoyuan, Taiwan
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Hutchings EJ, Waller JL, Terry AV. Differential long-term effects of haloperidol and risperidone on the acquisition and performance of tasks of spatial working and short-term memory and sustained attention in rats. J Pharmacol Exp Ther 2013; 347:547-56. [PMID: 24042161 DOI: 10.1124/jpet.113.209031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A common feature of the neuropsychiatric disorders for which antipsychotic drugs are prescribed is cognitive dysfunction, yet the effects of long-term antipsychotic treatment on cognition are largely unknown. In the current study, we evaluated the effects of long-term oral treatment with the first-generation antipsychotic haloperidol (1.0 and 2.0 mg/kg daily) and the second-generation antipsychotic risperidone (1.25 and 2.5 mg/kg daily) on the acquisition and performance of two radial-arm maze (RAM) tasks and a five-choice serial reaction-time task (5C-SRTT) in rats during days 15-60 and 84-320 days of treatment, respectively. In the RAM, neither antipsychotic significantly affected the acquisition or performance of a spatial win shift or a delayed non-match-to-position task. Conversely, in the rats administered 5C-SRTT, haloperidol was associated with profound deficits in performance, and the subjects were not able to progress through all stages of task acquisition. Depending on the dose, risperidone was associated with a greater number of trials to meet specific performance criteria during task acquisition compared with vehicle-treated controls; however, most subjects were eventually able to achieve all levels of task acquisition. Both haloperidol and risperidone also increased the number of perseverative and time-out responses during certain stages of task acquisition, and the response and reward latencies were slightly higher than controls during several stages of the study. These results in rats suggest that while long-term treatment with haloperidol or risperidone may not significantly affect spatial working or short-term memory, both antipsychotics can (depending on dose) impair sustained attention, decrease psychomotor speed, increase compulsive-type behaviors, and impair cognitive flexibility.
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Affiliation(s)
- Elizabeth J Hutchings
- Department of Pharmacology and Toxicology, Georgia Regents University, Augusta, Georgia (E.J.H., A.V.T.), Department of Biostatistics, Georgia Regents University, Augusta, Georgia (J.L.W.)
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20
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Segmiller FM, Hermisson I, Riedel M, Seemüller F, Volkamer T, Laux G, Möller HJ, Brunnauer A. Driving Ability According to German Guidelines in Stabilized Bipolar I and II Outpatients Receiving Lithium or Lamotrigine. J Clin Pharmacol 2013; 53:459-62. [DOI: 10.1002/jcph.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/23/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Felix M. Segmiller
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilians-University; Munich; Germany
| | - Igor Hermisson
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilians-University; Munich; Germany
| | | | - Florian Seemüller
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilians-University; Munich; Germany
| | - Thomas Volkamer
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilians-University; Munich; Germany
| | | | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilians-University; Munich; Germany
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Lipskaya-Velikovsky L, Kotler M, Weiss P, Kaspi M, Gamzo S, Ratzon N. Car driving in schizophrenia: can visual memory and organization make a difference? Disabil Rehabil 2013; 35:1734-9. [PMID: 23350755 DOI: 10.3109/09638288.2012.753116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Driving is a meaningful occupation which is ascribed to functional independence in schizophrenia. Although it is estimated that individuals with schizophrenia have two times more traffic accidents, little research has been done in this field. Present research explores differences in mental status, visual working memory and visual organization between drivers and non-drivers with schizophrenia in comparison to healthy drivers. METHODS There were three groups in the study: 20 drivers with schizophrenia, 20 non-driving individuals with schizophrenia and 20 drivers without schizophrenia (DWS). Visual perception was measured with Rey-Osterrieth Complex Figure test and a general cognitive status with Mini-Mental State Examination. RESULTS The general cognitive status predicted actual driving situation in people with schizophrenia. No statistically significant differences were found between driving and non-driving persons with schizophrenia on any of the visual parameters tested, although these abilities were significantly lower than those of DWS. CONCLUSION The research demonstrates that impairment of visual abilities does not prevent people with schizophrenia from driving and emphasizes the importance of general cognitive status for complex and multidimensional everyday tasks. The findings support the need for further investigation in the field of car driving for this population - a move that will considerably contribute to the participation and well-being. Implication for Rehabilitation Unique approach for driving evaluation in schizophrenia should be designed since direct applications of knowledge and practice acquired from other populations are not reliable. This research demonstrates that visual perception deficits in schizophrenia do not prevent clients from driving, and general cognitive status appeared to be a valid determinant for actual driving. We recommended usage of a general test of cognition such as Mini-Mental State Examination, or conjunction number of cognitive factors such as executive functions (e.g., Trail Making Test) and attention (e.g., Continuous Performance Test) in addition to spatial-visual ability tests (e.g., Rey-Osterrieth Complex Figure test) for considering driving status in schizophrenia.
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Affiliation(s)
- Lena Lipskaya-Velikovsky
- Department of Occupational Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel Aviv University , Tel Aviv , Israel
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Soyka M, Limmer C, Lehnert R, Koller G, Martin G, Küfner H, Kagerer S, Haberthür A. A comparison of cognitive function in patients under maintenance treatment with heroin, methadone, or buprenorphine and healthy controls: an open pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:497-508. [PMID: 21851203 DOI: 10.3109/00952990.2011.600381] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cognitive impairment has been reported in drug-dependent patients under opioid maintenance treatment. OBJECTIVES To compare cognitive functioning in healthy controls and in opioid-dependent patients treated with Buprenorphine, Heroin, or methadone maintenance. METHODS We used the standardized test battery ART-90 to study cognitive function in patients under long-term heroin treatment (n = 20), Bup (n = 22), or Met (n = 24) maintenance treatment and healthy controls (n = 25). RESULTS Patients receiving heroin performed significantly worse than healthy controls in most domains. Heroin patients performed worse than patients in the other two treatment groups in subtests measuring psychomotor performance under stress conditions and monotony. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Although a number of limitations must be taken into account, this study provides some preliminary evidence that cognitive function may be more impaired in patients under heroin maintenance treatment than in patients receiving Bup or Met and in healthy controls.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany.
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De Las Cuevas C, Ramallo Y, Sanz EJ. Psychomotor performance and fitness to drive: the influence of psychiatric disease and its pharmacological treatment. Psychiatry Res 2010; 176:236-41. [PMID: 20202690 DOI: 10.1016/j.psychres.2009.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 02/11/2009] [Accepted: 02/22/2009] [Indexed: 10/19/2022]
Abstract
Both psychiatric disorders and psychiatric drug treatments produce changes of psychomotor performance which can disturb and/or interfere with the ability to drive safely. We studied the influence of current psychiatric drug treatments on psychomotor functions and on driving performance of 77 consecutive psychiatric outpatients in two different clinical situations: at admission, when patients are destabilized and their mental disorders untreated, and after 6 weeks of pertinent psychotropic treatment. Fitness to drive and psychomotor performance were assessed using the electronic LNDETER 100 battery. Treatment effects on global functioning were assessed using the Clinical Global Impression of Change (CGIC) scale. One-way repeated measures analysis of variance and post hoc comparisons with the Bonferroni correction were performed. At the time of diagnosis, 90% of the patients failed to achieve scores sufficient to renew their driving licenses. After 6 weeks of adequate treatment, 83% improved their mental condition, and 17% either remained unchanged or deteriorated. Of those who improved, 25% had scores sufficiently high for them to drive legally, and the rest improved their performance from baseline assessment. Three of the four sub-tests were able to discriminate between patients with different clinical conditions. The study clearly suggests that medical treatment of psychiatric problems has a positive effect on driving tests.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Psychiatry, School of Medicine, University of La Laguna, San Cristóbal de La Laguna 38071, Canary Islands, Spain.
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Abstract
Abstract Objective. The objective of this study was to determine whether there is a relationship between the past utilization of four mental health services (i.e. ever been seen by a psychiatrist, ever been in a psychiatric hospital, ever been in counseling, ever been on psychotropic medication) and different types of driving citations during one's lifetime. Methods. Using a consecutive, cross-sectional, primary care sample, we surveyed participants about their past use of four mental health services and lifetime incidence of 29 different types of driving citations (charges, not convictions). Results. The total number of different types of moving violations was statistically significantly related to a history of psychiatric hospitalization. The total number of different types of non-moving violations was statistically significantly related to all mental health services variables. Conclusions. In this study, general non-specific queries about the past utilization of mental health services were correlated with both moving violations (past psychiatric hospitalization) and non-moving violations (all mental health services variables). These findings suggest that patients who have received mental health treatment are at a higher risk for being cited for driving violations than those who have not received mental health treatment. However, among the mental health variables under study, only past psychiatric hospitalization was associated with moving violations.
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Driving simulator performance and psychomotor functions of schizophrenic patients treated with antipsychotics. Eur Arch Psychiatry Clin Neurosci 2009; 259:483-9. [PMID: 19593580 DOI: 10.1007/s00406-009-0014-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
Abstract
The objective of the study is to compare schizophrenic inpatients under antipsychotic monotherapy regarding simulated driving behaviour and psychomotor functions related to driving ability. Schizophrenic inpatients (n = 80) were tested before discharge to outpatient treatment. Data were collected with the computerized Act & React Testsystem and the Wiener Testsystem measuring visual perception, reaction time, attention, vigilance and stress-tolerance. Besides, patients underwent various driving simulations on a static driving simulator (FT-SR 200). Before discharge to outpatient treatment, about 25% of schizophrenic patients must be considered as severely impaired with respect to driving skills. Differences between treatment groups could be shown both in psychomotor measures and in driving simulator performance with a better test performance of patients treated with atypical antipsychotics. Controlling for age, psychopathologic symptoms and extrapyramidal signs, differences in psychomotor measures were most pronounced in concentration and vigilance. As mental disorders itself pose an increased risk of accidents, counselling patients with respect to differential effects of antipsychotic treatment is of great relevance. In addition to psychomotor tests computer-simulated driving seems to be a useful tool in assessing traffic safety under pharmacologic treatment.
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De Las Cuevas C, Sanz EJ. Fitness to drive of psychiatric patients. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2009; 10:384-90. [PMID: 19158977 DOI: 10.4088/pcc.v10n0506] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Accepted: 02/28/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Driving a motor vehicle could be central to the functional autonomy of patients with psychiatric illnesses. For patients, a driver's license could mean independence, the ability to care for themselves, and the freedom to travel when they wish. However, both psychiatric disorders and psychiatric drug treatments can produce changes in perception, information processing and integration, and psychomotor activity that can disturb and/or interfere with the ability to drive safely. OBJECTIVE To assess the fitness to drive of psychiatric outpatients in a sample representative of current clinical practice. METHOD Cognitive functioning and psychomotor performance of 208 consecutive psychiatric outpatients treated in a community mental health center in the Canary Islands (Spain) were assessed in different clinical situations. The LNDETER 100 battery, an electronic assessment unit-based measurement that consists of 5 screenbased tests, was used to assess concentrated attention and resistance to monotony, multiple discriminative reactions and their correctness, anticipation of speed, bimanual coordination, and the decision making process and tendency to assume risk. The study was conducted from July 2007 to September 2007. RESULTS Of 208 patients, only 33 had scores compatible with the requirements of a driver's license, and 84% failed at least 1 of the required tests. Of patients with a driver's license who drive almost every day, 79.5% registered scores that would not allow obtaining or renewal of the license. None of the driving patients studied notified the traffic authorities that they had a psychiatric condition that may affect safe driving. No patient stopped driving, although 10% of them recognized that their ability to drive was somehow damaged. CONCLUSION Guidance on how best to formulate and deliver recommendations on driving fitness in stable psychiatric patients is lacking and much needed.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Psychiatry, School of Medicine, University of La Laguna, Tenerife, Canary Islands, Spain.
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Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study. Knee 2008; 15:295-8. [PMID: 18407504 DOI: 10.1016/j.knee.2008.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Revised: 02/19/2008] [Accepted: 02/21/2008] [Indexed: 02/02/2023]
Abstract
Patients undergoing total knee arthroplasty often ask when they can safely resume car driving. There is little evidence available on which physicians can rely when advising patients on this issue. In a prospective study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery. On each measurement day the patients performed two tasks, a simple and a complex brake response time task in a car simulator. Ten days after left TKA the brake response time for the simple task had decreased by 3.6% (p=0.24), the reaction time by 3.1% (p=0.34) and the movement time by 6.6% (p=0.07). However, the performance improvement was not statistically significant. Task complexity increased brake response time at both time points. A 5.8% increase was significant (p=0.01) at 10 days after surgery. Based on our results, we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission.
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Abstract
Driving a motor vehicle is central to the functional autonomy of patients with psychiatric illnesses. There have been many studies of the deleterious effects of psychotropic medications such as benzodiazepines, typical antipsychotics and tricyclic antidepressants (TCAs) on human motor skills; however, in the literature little attention has been paid to how such impairment affects driving ability. Computerised driving simulators offer a laboratory-based method of assessing the effects of specific psychotropic medications on driving abilities, in a standardised, controlled and safe manner. The purpose of the present article is to review research undertaken to-date on the effects of psychotropic medications on computer-simulated driving. A search of various databases, including MEDLINE, EMBASE and PsycInfo, was conducted. Forty-one articles assessing the impact of psychotropics on computer-simulated driving were identified. The pooled total number of subjects assessed in these simulator studies was 1336 (mean sample size 30.36 [SD 35.8]). The most common outcome measures in the various studies were speed, steering, deviation from lateral position (tracking, lane drifting), reaction time or braking accuracy, driving errors (e.g. errors in turning, coordination, gap acceptance, signalling, following distance) and vehicle collisions. The results of the studies were quite variable; however, the most common drug-related impairments included those of tracking and reaction time. Benzodiazepines and TCAs were most commonly associated with impairment, although the level of impairment was dependent on the population studied, the dose and the time of testing relative to drug administration. Computer-simulated driving provides a useful tool to research psychotropic-related impairment of driving abilities. Limitations of currently available data include the lack of generalisability, standardisation and small sample sizes.
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Affiliation(s)
- Mark J Rapoport
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Crone D. Walking back to health: a qualitative investigation into service users' experiences of a walking project. Issues Ment Health Nurs 2007; 28:167-83. [PMID: 17365166 DOI: 10.1080/01612840601096453] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The relationship between physical activity and mental health is well documented and has led to the inclusion of physical activity into the treatment of people with mental health problems within heath care. However, little research has been conducted on the outcomes these programmes have for the people who participate in them. This study investigated the perceived health outcomes of people with mental health problems who had successfully participated in a walking project. The research is a descriptive qualitative study that used individual interviews and the constant comparative method of analysis. Findings conclude that physical activity programmes have a significant part to play in the quality of life of people with mental health problems and have the potential to be an integral part of their health care.
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Affiliation(s)
- Diane Crone
- University of Gloucestershire, Gloucester, United Kingdom.
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Reimer B, D'Ambrosio LA, Coughlin JE, Kafrissen ME, Biederman J. Using self-reported data to assess the validity of driving simulation data. Behav Res Methods 2006; 38:314-24. [PMID: 16956108 DOI: 10.3758/bf03192783] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this article, we use self-reported driving behaviors from a written questionnaire to assess the measurement validity of data derived from a driving simulation. The issue of validity concerns the extent to which measures from the experimental context map onto constructs of interest. Following a description of the experimental methods and setting, an argument for the face validity of the data is advanced. Convergent validity was assessed by regressing behaviors observed in thedriving simulatoron self-reported measures of driving behaviors. Significant relationships were found across six measures: accidents, speeding, velocity, passing, weaving between traffic, and behavior at stop signs. Concurrent validity was evaluated with an analysis of simulator accident involvement and attention deficit hyperactivity disorder status. Discriminant validity was assessed using a multitrait-multimethod matrix of simulator and questionnaire data. We concluded that although the relationship between self-reported behaviors and observed responses in the simulator falls short of perfect correspondence, the data collected from the driving simulator are valid measures of the behaviors of interest.
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Affiliation(s)
- Bryan Reimer
- Massachusetts Institute of Technology, Cambridge, Massachusetts and Massachusetts General Hospital, Boston, Massachusetts 02139, USA.
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Soyka M, Hock B, Kagerer S, Lehnert R, Limmer C, Kuefner H. Less impairment on one portion of a driving-relevant psychomotor battery in buprenorphine-maintained than in methadone-maintained patients: results of a randomized clinical trial. J Clin Psychopharmacol 2005; 25:490-3. [PMID: 16160628 DOI: 10.1097/01.jcp.0000178417.60426.60] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment in drug-dependent patients under methadone maintenance treatment has been reported before. We assessed whether patients under buprenorphine, a partial mu-opioid agonist, perform better in cognitive tests measuring psychomotor performance as described in previous nonrandomized studies. METHODS We performed a randomized clinical trial in 62 drug-dependent patients under either buprenorphine or methadone treatment. Sixteen patients dropped out of maintenance therapy, before the testing was performed, after 8 to 10 weeks of treatment. Several subtests of the Act & React Test System test battery were used measuring visual perception, selective attention, vigilance, reactivity, and stress tolerance. FINDINGS Although there were no differences in cognitive function at baseline, patients under buprenorphine treatment showed partially better results in some of the domains tested. The used tests are relevant when assessing driving ability. There was a significant correlation between dose of buprenorphine and some test results. We also found a correlation between age and reaction time and between duration of opioid dependence and results in some subtests. INTERPRETATIONS (CONCLUSIONS): When comparing both treatments in drug dependent patients, buprenorphine produces partially less impairment on cognitive functions in some of the subtests of the psychomotor battery than methadone. This difference is specially relevant when it comes to driving ability and social functioning.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, Germany.
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Soyka M, Kagerer S, Brunnauer A, Laux G, Möller HJ. Driving ability in schizophrenic patients: effects of neuroleptics. Int J Psychiatry Clin Pract 2005; 9:168-74. [PMID: 24937786 DOI: 10.1080/13651500510029237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent studies indicate that individuals with schizophrenia have a two-fold incidence of traffic accidents. Cognitive and psychomotor impairment as a core feature of schizophrenia and the effects of neuroleptic treatment play an essential role in this respect. Few experimental studies have been conducted so far looking at the effects of neuroleptics on driving ability in schizophrenia. Controlled, randomised trials are totally missing. The limited database indicates that most schizophrenic patients show significant impairment in cognitive functions relevant for driving ability compared to healthy controls. There is some but limited evidence that patients under novel atypical neuroleptics show less impairment compared to conventional neuroleptics. More clinical and experimental studies are warranted.
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Soyka M, Winter C, Kagerer S, Brunnauer M, Laux G, Möller HJ. Effects of haloperidol and risperidone on psychomotor performance relevant to driving ability in schizophrenic patients compared to healthy controls. J Psychiatr Res 2005; 39:101-8. [PMID: 15504428 DOI: 10.1016/j.jpsychires.2004.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2003] [Revised: 04/20/2004] [Accepted: 04/22/2004] [Indexed: 11/29/2022]
Abstract
The effects of antipsychotic treatment on the psychomotor performance and driving ability of schizophrenic patients is subject of investigation. The present study was designed to evaluate the effects of an atypical neuroleptic (risperidone) in comparison to a conventional dopamine antagonist neuroleptic (haloperidol) on several dimensions of psychomotor performance (visual perception, attention, reaction time, and sensorimotor performance) considered to be of relevance in evaluating driving fitness. Psychomotor performance was assessed by means of the ART 90 (act-and-react test), a computerized test battery which is frequently used in diagnosis of psychomotor performance. The 40 participating patients were examined at discharge following psychopathological stabilisation; 20 received haloperidol medication, 20 received the atypical neuroleptic risperidone. Nineteen healthy individuals were studied as a control group. Our findings indicate a remarkably reduced psychomotor performance in both groups of schizophrenic patients compared to healthy controls. We did find a significant but low correlation between age and some items of the RST3 and between age and the tracking performance on the PVT. The younger patients showed a better test performance than older patients. The BPRS-score was significantly correlated with only two items of the RST3. However, patients under treatment with risperidone showed significantly better results compared to patients treated with haloperidol. Only one (5%) subject passed all subtests without major failures and could be regarded as competent to drive. Among patients with risperidone, seven patients (35%) passed all test parameters without major failures. Clinical implications of these findings are discussed.
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Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, Ludwig-Maximilians-University of Munich, Naussbaumstrasse 7, D-80336 Munich, Germany
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Brunnauer A, Laux G, Laux G, Geiger E. Fahrtüchtigkeit und psychische Erkrankung. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2004. [DOI: 10.1024/1016-264x.15.3.209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Psychische Erkrankungen gehen oft mit Störungen der Informationsverarbeitung einher, die bei den Betroffenen zu Beeinträchtigungen in weiten Bereichen des alltäglichen Lebens führen können. Ein Beispiel für die vielfältigen Alltagsrisiken stellt der Straßenverkehr dar. Die epidemiologische Datenlage in Bezug auf Unfallrisiken von psychiatrischen Patienten unter Psychopharmaka ist jedoch dünn und von einer Reihe von methodischen Problemen gekennzeichnet. Einige Untersuchungen weisen auf ein erhöhtes Risiko von psychiatrischen Patienten hin, in einen Verkehrsunfall verwickelt zu werden. Eine pauschale Bewertung von Arzneimitteln, die die Fahrtüchtigkeit beeinträchtigen können ist nicht möglich. Unter den potenziell verkehrsbeeinträchtigenden Psychopharmaka stehen Tranquilizer und Hypnotika an erster Stelle. Im Gegensatz zu vielen trizyklischen Antidepressiva führen neuere selektive Antidepressiva zu keinen signifikanten Beeinträchtigungen psychomotorischer und kognitiver Funktionen. Neuere atypische Antipsychotika scheinen hinsichtlich Vigilanz und Psychomotorik Vorteile gegenüber konventionellen Neuroleptika zu haben. Die Beratung und Aufklärung von Patienten zu Fragen der Fahrtauglichkeit muss individuell, unter Berücksichtigung des Krankheitsbildes, pharmaka-differenzieller Aspekte sowie beruflichen und sozialen Wiedereingliederungsbemühungen erfolgen.
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Affiliation(s)
- Alexander Brunnauer
- Bezirksklinikum Gabersee, Fachkrankenhaus für Psychiatrie, Psychotherapie und Neurologie, Wasserburg a. Inn
| | - Gerd Laux
- Bezirksklinikum Gabersee, Fachkrankenhaus für Psychiatrie, Psychotherapie und Neurologie, Wasserburg a. Inn
| | - Gerd Laux
- Psychiatrische Universitätsklinik, Ludwig-Maximilians-Universität, München
| | - Elisabeth Geiger
- Bezirksklinikum Gabersee, Fachkrankenhaus für Psychiatrie, Psychotherapie und Neurologie, Wasserburg a. Inn
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