Fitness to drive of psychiatric patients

Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study

Background

Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE).

Methods

A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening.

Results

Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver’s distraction score, the likelihood of a car crash being reported increased by 4.9%.

Conclusion

Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.

Driver assessment service for people with mental illness

Mental illness often leads to functional deficits that likely affect one’s driving performance and may even pose threat to other road users. However, having a mental illness does not automatically preclude one from driving which is essential to mobility and productivity. Indeed, evaluating their fitness-to-drive would be of necessary. Despite that, there is still a lack of a local driving evaluation service that specifically addresses the impact of mental illness on driving capacity. This paper discusses the needs to evaluate the fitness-to-drive of people with mental illness. It advocates the development of such specific driver assessment service with a local example as illustration. Lastly, some of the challenges related to the drivers’ responsibility to declare personal health status and large variety of assessment approaches are also discussed.

A review of impaired visual processing and the daily visual world in patients with schizophrenia

Several studies have investigated perceptual processes in patients with schizophrenia. Research confirms that visual impairments are one of the most important features of schizophrenia. Many studies, using behavioral and psychological experiments, confirm that visual impairments can be used to determine illness severity, state, and best treatments. Herein, we review recent research pertaining to visual function in patients with schizophrenia and highlight the relationship between laboratory findings and subjective, real-life reports from patients themselves. The purpose of this review is to 1) describe visual impairments that manifest in patients with schizophrenia, 2) examine the relationship between visual dysfunction, assessed by laboratory tests, and the experiences of patients themselves, and 3) describe real-life experiences related to visual function in this population. In this review, the impairments of motion and color perception, perceptual organization, and scan paths are summarized, along with the relationship between laboratory findings and patients' real-world subjective experiences related to visual function.

Driving performance of stable outpatients with depression undergoing real-world treatment

AIM

Although the effects of psychotropics on driving ability have received much attention, little research is available on driving performance of stable outpatients with depression undergoing real-world treatment. This observational study investigated driving performance, cognitive functions, and depressive symptomatology of partly remitted outpatients with depression under daily-practice psychopharmacologic treatment.

METHODS

Seventy stable outpatients with depression and 67 healthy volunteers were enrolled. Patients' prescriptions were not controlled in order to capture the real-world treatment environment. Participants underwent three driving tasks - road-tracking, car-following, and harsh-braking - using a driving simulator, and three cognitive tasks - Continuous Performance Test, Wisconsin Card Sorting Test, and Trail-Making Test. The Symptom Assessment Scale - Structured Interview Guide for the Hamilton Depression Rating Scale, Beck Depression Inventory-II, Social Adaptation Self-Evaluation Scale, and Stanford Sleepiness Scale were also completed.

RESULTS

Although many patients received various pharmacologic treatments, there were no significant differences in the three driving tasks between outpatients with depression and healthy controls. Difficulty of maintaining set in the Wisconsin Card Sorting Test was significantly increased in patients with depression. Results on the Social Adaptation Self-Evaluation Scale were significantly associated with road-tracking and car-following performance, in contrast to results on the Hamilton Depression Rating Scale and the Beck Depression Inventory-II.

CONCLUSION

We conclude that partly remitted depressive patients under steady-state pharmacologic treatment do not differ from healthy controls with respect to driving performance, which seems to be more affected by psychosocial functioning than by pharmacologic agents. This, however, should be investigated systematically in an off/on study.

A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder

BACKGROUND

Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving.

METHODS

A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols.

RESULTS

A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting.

CONCLUSIONS

There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive.

A study of psychiatric referrals for fitness for work

BACKGROUND

There are very few Indian studies regarding the psychiatric evaluation of state government workers referred for psychiatric fitness for work.

AIM

This study aimed to examine the reasons for referral, psychiatric diagnosis, and outcome of psychiatric referrals for fitness for work at a tertiary-level referral government hospital.

MATERIALS AND METHODS

The study evaluated consecutive psychiatric referrals at a tertiary-level referral government hospital with their informed consent utilizing a specially prepared pro forma, Kuppuswamy's Socioeconomic Status Scale and the Mini International Neuropsychiatric Interview plus. Psychiatric diagnoses were based on the International Classification of Diseases 10th Edition Diagnostic Criteria for Research.

RESULTS

The study included 67 male and 8 female psychiatric referrals with a mean age of 39.5 years. Most of the psychiatric referrals were married (82.6%), Hindu by religion (97.3%), from urban areas (80%), belonged to upper middle class (46.7%), and had rotating shifts or emergency duties (50%). Psychiatric referrals were usually made for a single reason (57%), most commonly absenteeism (84%) followed by undisciplined behavior (38%). A past history of disciplinary action taken against them was given by 56% of the referrals. The most common psychiatric diagnosis was psychoactive substance-use disorder (21.3%) followed by psychotic disorders (20%) and mood disorders (14.7%). No psychopathology was detected in 18.7% of the referrals. Most of the psychiatric referrals (68%) were fit for work, though 22.67% were declared unfit for work (permanent invalidation). Psychiatric referrals with multiple reasons for referrals, longer duration of psychiatric illness (>5 years), and diagnosis of organic mental disorder or psychotic disorder received invalidation (permanent unfitness) on psychiatric grounds.

CONCLUSIONS

Psychiatric referral for fitness for work is most commonly for absenteeism. The most common psychiatric diagnosis was substance-use disorder followed by psychoses. The majority (68%) were found fit for work after treatment though 22.6% required invalidment from service.

Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland

Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.

Psychotropic drugs and driving: prevalence and types

BACKGROUND

Some psychotropic medications (e.g., benzodiazepines, sedative antidepressants, etc.) may impair cognitive and psychomotor functions and, therefore, endanger traffic safety (Ravera, Br J Clin Pharmacol, 72(3):505-513, 2011). They affect detection, registration, and information processing, problem solving, and decision-making processes, and they also affect emotional and social aspects. The objective of this research was to clarify three closely related issues that are significant for traffic safety: the prevalence of psychotropic drugs on driving, the most frequently used psychotropic drugs to treat depression, anxiety, insomnia, or any tranquilizers (whether it is a medical prescription or self-medication), and finally, provide a further understanding of the socio-demographic and psycho-social characteristics of drivers related to the psychotropic drugs consumption in Spain.

METHODS

A sample of 1,200 Spanish drivers ranging from 18 to 64 years was used, 666 men and 534 women were asked to answer a questionnaire composed by a set of questions structured in different sections. The only selection criteria were to be in possession of any type of driving license for vehicles other than motorcycles and drive frequently.

RESULTS

The results showed that 15% of the participants were consuming psychotropic drugs to treat depressive disorders, anxiety disorders, insomnia, or tranquilizers; 13.5% were using drugs to treat one of these disorders; while 1.5% used them for several of these disorders. A 2.5% of drivers were using medicines to treat depression, 2.6% to treat anxiety, and 3.7% to treat insomnia. The 8.3% of those drivers who were not using any drugs to treat these three disorders were occasionally using some type of tranquilizers. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) were the most used type of medicines among drivers. Benzodiazepines were the most used medicines to treat anxiety, while SSRIs were the most used to treat depression, 56.5% and 43.5%, respectively.

CONCLUSIONS

Measures can be developed to reduce traffic accidents caused by the effects of these drugs; however, this will only be possible once the drivers and the use of these drugs are understood. Health care professionals and patients should be properly informed about the potential effects of some psychotropic medications on driving abilities considering individual and group differences.

Neural correlates of visual motion prediction

Predicting the trajectories of moving objects in our surroundings is important for many life scenarios, such as driving, walking, reaching, hunting and combat. We determined human subjects’ performance and task-related brain activity in a motion trajectory prediction task. The task required spatial and motion working memory as well as the ability to extrapolate motion information in time to predict future object locations. We showed that the neural circuits associated with motion prediction included frontal, parietal and insular cortex, as well as the thalamus and the visual cortex. Interestingly, deactivation of many of these regions seemed to be more closely related to task performance. The differential activity during motion prediction vs. direct observation was also correlated with task performance. The neural networks involved in our visual motion prediction task are significantly different from those that underlie visual motion memory and imagery. Our results set the stage for the examination of the effects of deficiencies in these networks, such as those caused by aging and mental disorders, on visual motion prediction and its consequences on mobility related daily activities.

[Doctors' views on medical assessments of drivers]

BACKGROUND

Medical assessment of drivers and completion of a health certificate (required for getting a driver's licence for certain groups in Norway) is a difficult task to handle for many doctors. We wanted to gain more knowledge of what doctors find most difficult and the type of assistance they feel would be helpful.

MATERIAL AND METHODS

Based on their own experience, the authors developed a questionnaire with 13 questions; two open and 11 closed questions, and a possibility to write more detailed answers for four of the questions. The questionnaire was sent to a random sample of Norwegian doctors; 680 general practitioners (GPs) and 493 specialists within neurology, physical medicine and rehabilitation, psychiatry, and geriatrics. One reminder was sent. Answers to questions were categorised and frequency analyses performed.

RESULTS

The response rate was 52 % for GPs and 55 % for specialists. GPs reported that cognitive impairment, advanced age; substance abuse and alcohol problems were the most difficult areas to assess, while the specialist group found that substance abuse and alcohol problems, psychiatric disease and use of different medications were most difficult. The doctors are not satisfied with the assistance provided by the authorities in this area, and specifically ask for a specialised agency to which they can refer patients for assessment.

INTERPRETATION

More specific guidelines and a formal second-line system would facilitate the burden on doctors.

Mental health services utilization and driving violations

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.

Driving on antidepressants: cruising for a crash?

Antidepressants are commonly prescribed medications that carry an imprecise risk of driving impairment. In this edition of The Interface, we explore the relationship between antidepressant medications and driving impairment. We conclude that while there may be a small risk of driving impairment with these medications, this risk is considerably heightened under particular clinical conditions. These conditions include the advanced age of the driver, initial dosing and start-up of the antidepressant, rapid escalation of antidepressant doses, high-dose antidepressants, presence of active and severe depressive symptoms (i.e., the antidepressant is merely functioning as a pharmacological marker for severe depressive illness), and/or coadministration of other psychotropic medications, especially benzodiazepines. Clinicians need to be mindful of these specific clinical conditions when prescribing antidepressants to patients.