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.
Int J Neuropsychopharmacol. 2021 Sep 21;24(9):679-693. doi: 10.1093/ijnp/pyab031.
Mobility is important for daily life functioning, with particular challenges regarding road safety under pharmacological treatment in patients with a psychiatric disease.
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.
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.
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.
行动能力对于日常生活功能很重要，在精神病患者进行药物治疗时，尤其需要关注与道路安全相关的问题。
根据 PRISMA 指南，对 PubMed 数据库（1970 年 1 月至 2020 年 12 月）进行了系统的文献检索。主要终点是根据患者研究中的法律规定，通过评估道路测试、驾驶模拟器性能或精神运动和视觉感知功能来评估驾驶能力的驾驶表现。
确定了 40 项研究（1533 名患者，38%为女性，中位年龄 45 岁），其中超过 60%为横断面和开放性试验。在稳态药物治疗下，31%（范围 27%-42.5%）的精神分裂症或分裂情感障碍患者服用抗精神病药，18%（范围 16%-20%）的单相和双相患者服用抗抑郁药时，驾驶相关技能严重受损。数据表明第二代抗精神病药优于第一代抗精神病药，以及现代抗抑郁药优于三环类抗抑郁药。大多数患者在非镇静或镇静抗抑郁药治疗的 2-4 周内，驾驶技能显著改善或稳定。地西泮在治疗开始后的前 3 周显著恶化驾驶能力，而咪达唑仑（低剂量）、替马西泮和唑吡坦则不会损害驾驶能力。在长期使用镇静抗抑郁药或苯二氮䓬类药物的患者中，在道路测试中并没有明显的损伤。
现有证据表明，在临床考虑的情况下，当给予长期治疗的患者时，精神药理学药物可以改善或至少稳定驾驶表现。为了提高治疗依从性，关于药物对驾驶性能影响的现有药物分类系统也应纳入关于长期治疗效果的信息。
