Psychiatric illness, psychotropic drugs and driving ability

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



Conflict of interest statement

• I have received fees and travel grants from

– Lundbeck GmbH

– Outsuka Pharma GmbH

– Servier GmbH

within the last 3 years



Mobility General Population - Survey Germany

(INFAS and DLR, 2010)Percent having a driving licence



Perc

enta

ge

(Brunnauer et al., 2016)

• Multicentre study• N=1810 patients

Driving Status – Psychiatric Patients

Mobility – Psychiatric Patients



Possession of a driving-license and driving cessation

Possession - predictive factorsBeing married, partnered or divorcedHaving a graduationSubstance dependenceSchizophrenic disorderLonger duration of illness


Cessation - predictive factorsOlder ageBeing femaleDrawing a pensionSubstance dependenceSchizophrenic disorder



Predominant purpose of the drives

(Brunnauer et al., 2016 and INFAS/DLR, 2010)



Cognitive impairment in psychiatric disorders

(Millan et al. 2012)



(Hoff et al., 1999)

Cognition and schizophrenia



(Rock et al. 2013)

Cognition and depression

Depressed patients

Remitted depressed patients



Depression and Driving Ability –(partly) remitted depressive patients


Functional domains• Visual Perception• Reactivity• Stress Tolerance• Attention• Concentration

Demands according to the German Guidelines for Road and Traffic Safety




Schizophrenia and Driving Ability –(partly) remitted patients

Demands according to the German Guidelines for Road and Traffic Safety



(Segmiller et al. 2015)

Schizophrenia and Driving Ability –untreated patients



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)



Prescription Data GermanyDDD

Year (adapted from Schwabe u. Paffrath, 2016)



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)



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)



x-fold increased risk (adapted from Elvik, 2013)

Accident risk for driving with psychoactive

substances



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



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 !

Psychiatric illness, psychotropic drugs and driving ability

Health & Medicine

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