psychiatric illness, psychotropic drugs and driving ability
TRANSCRIPT
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Psychiatric illness, psychotropic drugs and driving ability
Alexander Brunnauer
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Conflict of interest statement
• I have received fees and travel grants from
– Lundbeck GmbH
– Outsuka Pharma GmbH
– Servier GmbH
within the last 3 years
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Mobility General Population - Survey Germany
(INFAS and DLR, 2010)Percent having a driving licence
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Perc
enta
ge
(Brunnauer et al., 2016)
• Multicentre study• N=1810 patients
Driving Status – Psychiatric Patients
Mobility – Psychiatric Patients
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Possession of a driving-license and driving cessation
Possession - predictive factorsBeing married, partnered or divorcedHaving a graduationSubstance dependenceSchizophrenic disorderLonger duration of illness
(Brunnauer et al., 2016)
Cessation - predictive factorsOlder ageBeing femaleDrawing a pensionSubstance dependenceSchizophrenic disorder
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Predominant purpose of the drives
(Brunnauer et al., 2016 and INFAS/DLR, 2010)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Cognitive impairment in psychiatric disorders
(Millan et al. 2012)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
(Hoff et al., 1999)
Cognition and schizophrenia
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
(Rock et al. 2013)
Cognition and depression
Depressed patients
Remitted depressed patients
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Depression and Driving Ability –(partly) remitted depressive patients
(Brunnauer et al., 2006)
Functional domains• Visual Perception• Reactivity• Stress Tolerance• Attention• Concentration
Demands according to the German Guidelines for Road and Traffic Safety
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
(Brunnauer et al., 2004)
Schizophrenia and Driving Ability –(partly) remitted patients
Demands according to the German Guidelines for Road and Traffic Safety
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
(Segmiller et al. 2015)
Schizophrenia and Driving Ability –untreated patients
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Relative crash risk of medical conditions
Condition Prevalence %(in licensed drivers)
Overall crash risk
Post-treatment crash risk
Psychiatric disorders
25%(includes substance abuse)
2.1 – 5.0 Higher with benzodiazepinesMethodological problems distinguishing risk assoc. with drug v.s. condition
ADHD 3-7% Inconclusive InconclusiveAlcoholism 0.8% 2.1 – 5.0 InconclusiveAnxiety disorders 4,9% Inconclusive InconclusiveDementia 1.0% 2.1 – 5.0 InconclusiveDepression 3-5% Inconclusive Higher with trizyclics
Methodological problems distinguishing risk assoc. with drug v.s. condition
Personality disorders
1-10% Inconclusive Inconclusive
Schizophrenia 1% 2.1 – 5.0 InconclusiveYoung drivers (<20 y)
5-6% >5.0 -----------(adapted from Charlton et al., 2010)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Prescription Data GermanyDDD
Year (adapted from Schwabe u. Paffrath, 2016)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Prevalence of psychoactive medicines in relation to road
safety – DRUID WP2
General driving populationPrevalence% (EU)
Psychoactive medicines
0,17% – 2,99%
Benzodiazepines 0,14% - 2,73% • Most prevalent in drivers aged 35+• More prevalent in female drivers
Z-drugs 0,00% - 0,69% • Relatively often combined with other drugs
Medicinal opiates and opioids
0,00% – 0,79% • Often combined with other drugs• Most prevalent in drivers aged 35+• More prevalent in female drivers
(adapted from Schulze et al., 2012)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Seriously injured and killed driversResponsibility studies 6% of all tested drivers were under the influence of
psychoactive medicines – mainly benzodiazepines
Benzodiazepines – injured drivers
0,0% - 10,2% • Third most frequent finding after alcohol and THC• Most prevalent in drivers aged 35+• More prevalent in male drivers• Often combined with alcohol
Benzodiazepines – killed drivers
1,8% -13,3% • Second most found substance after alcohol followed by amphetamines• Most prevalent in drivers aged 35+• More prevalent in male drivers• Often combined with alcohol
Prevalence of psychoactive medicines in relation to road
safety – DRUID WP2
(adapted from Schulze et al., 2012)
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
x-fold increased risk (adapted from Elvik, 2013)
Accident risk for driving with psychoactive
substances
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Summary
Driving is a relevant issue for psychiatric patients
Mental illness has a negative impact on road mobility
It can be assumed that driving restrictions largely affect the social functioning of patients
Neurocognitive impairments related to driving skills are prevalent in most psychiatric disorders
Epidemiology points to an elevated crash-risk for patients with a psychiatric illness - especially for alcoholism, dementia and schizophrenia
Within psychoactive medicines benzodiazepines and amphetamines were the most frequent finding in seriously injured and killed drivers
Driving Ability and Psychotropic Drugs – EPA 25th European Congress of Psychiatry - 1-4 April
2017, Florence /Italy
Prof. Dr. P. Zwanzger Prof. Dr. P. FalkaiK. Aßmus Dr. C. CimpianuDr. V. Buschert E. LehmannA. Geidobler Dr. F. SegmillerG. SeidlM. WendeM. Wolf Prof. Dr. G. LauxL. Zellner
Dipl.-Psych. S. HoffmannDr. M. Schumacher Dr. Y. Kaussner
Dr. R. Kenntner-Mabiala
Thank you for y
our
attention !