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      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

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          Abstract

          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.

          Electronic supplementary material

          The online version of this article (10.1186/s12888-017-1481-1) contains supplementary material, which is available to authorized users.

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          Most cited references 40

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          Cognitive, sensory and physical factors enabling driving safety in older adults.

          We reviewed literature on cognitive, sensory, motor and physical factors associated with safe driving and crash risk in older adults with the goal of developing a model of factors enabling safe driving behaviour. Thirteen empirical studies reporting associations between cognitive, sensory, motor and physical factors and either self-reported crashes, state crash records or on-road driving measures were identified. Measures of attention, reaction time, memory, executive function, mental status, visual function, and physical function variables were associated with driving outcome measures. Self-monitoring was also identified as a factor that may moderate observed effects by influencing driving behavior. We propose that three enabling factors (cognition, sensory function and physical function/medical conditions) predict driving ability, but that accurate self-monitoring of these enabling factors is required for safe driving behaviour.
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            A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance.

            Attention-Deficit/Hyperactivity Disorder (ADHD) may interfere with driving competence, predisposing those with the disorder to impaired driving performance and greater risk for adverse driving outcomes. Effective treatment may minimize the risk in those with ADHD. We reviewed the scientific literature on driving risks and impairments associated with ADHD and the effects of stimulants on driving performance. Several lines of evidence were considered, including longitudinal studies and community-derived sample studies. The present review is based on a weekly review (by the first author) of all journals in the behavioral and social sciences indexed in the publication Current Contents spanning the past 15 years, as well as a search of the reference section of all studies found that pertained to driving risks associated with ADHD or to the treatment of ADHD as it relates to driving difficulties. The review of the scientific literature demonstrated well-documented driving risks and impairments associated with ADHD and the positive effects of stimulant medications on driving performance. Clinicians should educate patients/caregivers about the increased risk of adverse outcomes among untreated individuals with ADHD and the role of medication in potentially improving driving performance. Owing to the significantly higher risk of adverse driving outcomes, the use of stimulant medications to treat people with ADHD who drive may reduce such safety risks.
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              Neuropsychological function in young patients with unipolar major depression.

              While neuropsychological studies have consistently reported impaired cognition in elderly patients with unipolar depression, studies of cognitive function in younger patients with depression have produced equivocal results. The aim of this study was to examine the presence and nature of cognitive deficits in young patients with depression. Neuropsychological function was assessed in 20 young patients with unipolar depression, in comparison to 20 age-, education- and IQ- matched controls. Subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were employed, as this battery has proved sensitive to deficits in middle-aged and elderly patients with depression. The patients were not impaired for short-term memory capacity, spatial working memory, planning ability, cognitive speed, delayed matching to sample or recognition memory. Compared to controls, the patients showed impaired subsequent movement latencies on the Tower of London task, suggesting deficits in the ability to sustain motor responses in depression. The depression group were also impaired on the task of attentional set shifting, requiring more trials to criterion at the intradimensional stage of the task and being more likely to fail the task at the extradimensional shift stage than controls. Further analysis indicated that half of the depression group failed to complete all stages of the set shifting task. These patients were more likely to have required in-patient hospitalization at some time during their illness. These results indicate that there are specific cognitive deficits in young patients with depression and that their presence may be related to a history of hospitalization.
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                Author and article information

                Contributors
                c.unsworth@cqu.edu.au
                Anne.Baker@acu.edu.au
                heysh1121@gmail.com
                priscilla.harries@brunel.ac.uk
                Desmond.ONeill@amnch.ie
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                31 August 2017
                31 August 2017
                2017
                : 17
                Affiliations
                [1 ]ISNI 0000 0001 2193 0854, GRID grid.1023.0, Central Queensland University, ; Melbourne, Australia
                [2 ]ISNI 0000 0001 2194 1270, GRID grid.411958.0, Australian Catholic University, ; Melbourne, Australia
                [3 ]ISNI 0000 0001 0724 6933, GRID grid.7728.a, Brunel University London, ; London, UK
                [4 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Trinity College, ; Dublin, Republic of Ireland
                Article
                1481
                10.1186/s12888-017-1481-1
                5579945
                28859696
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Clinical Psychology & Psychiatry

                fitness-to-drive, mental health, systematic review

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