Staples John A, Daly-Grafstein Daniel, Khan Mayesha, Pei Lulu X, Erdelyi Shannon, Rezansoff Stefanie N, Chan Herbert, Honer William G, Brubacher Jeffrey R
Departments of Medicine (Staples, Daly-Grafstein, Khan) and Emergency Medicine (Pei, Erdelyi, Chan, Brubacher), University of British Columbia; Faculty of Health Sciences (Rezansoff), Simon Fraser University; Department of Psychiatry (Honer), University of British Columbia, Vancouver, BC.
CMAJ. 2025 Jun 8;197(22):E612-E619. doi: 10.1503/cmaj.250020.
Among individuals with schizophrenia, antipsychotic medications improve performance across several cognitive and functional domains. We sought to assess whether antipsychotic adherence reduces the risk of a motor vehicle crash.
We performed a case-crossover study using population-based administrative health and driving data from British Columbia, Canada. We included individuals with schizophrenia who were involved as a driver in a police-attended motor vehicle crash during a 15-year interval (2001-2016) and who filled prescriptions for antipsychotic medication as an outpatient in the 2 years before the crash. We measured adherence to antipsychotic treatment by using prescription fill data to calculate the medication possession ratio (MPR) in the 30 days before the crash (the pre-crash interval) and in a 30-day control interval ending 1 year before the crash. We used conditional logistic regression to evaluate the association between MPR and motor vehicle crash after adjusting for potential confounders.
Among 1130 eligible motor vehicle crashes involving drivers with schizophrenia, the mean antipsychotic MPR was 0.69 in the pre-crash intervals and 0.76 in the control intervals. We found that perfect adherence to antipsychotic medication was associated with half the odds of a crash relative to complete nonadherence (adjusted odds ratio 0.50, 95% confidence interval 0.38-0.66). The findings were consistent among subgroups defined by sex, age, and history of alcohol or drug misuse.
Better adherence to antipsychotic medications was associated with lower crash risk. Physicians and fitness-to-drive policy-makers might consider antipsychotic treatment adherence as a condition for maintaining an active driver's licence among individuals with schizophrenia.
在精神分裂症患者中，抗精神病药物可改善多个认知和功能领域的表现。我们试图评估坚持服用抗精神病药物是否能降低机动车碰撞事故的风险。
我们利用加拿大不列颠哥伦比亚省基于人群的行政健康和驾驶数据进行了一项病例交叉研究。我们纳入了在15年期间（2001 - 2016年）作为驾驶员卷入警方处理的机动车碰撞事故且在事故发生前2年作为门诊患者开具抗精神病药物处方的精神分裂症患者。我们通过使用处方配药数据来计算事故前30天（事故前间隔期）和事故前1年结束的30天对照间隔期内的药物持有率（MPR），以此衡量对抗精神病药物治疗的依从性。在调整潜在混杂因素后，我们使用条件逻辑回归来评估MPR与机动车碰撞事故之间的关联。
在1130起涉及精神分裂症驾驶员的符合条件的机动车碰撞事故中，事故前间隔期的抗精神病药物MPR均值为0.69，对照间隔期为0.76。我们发现，相对于完全不依从，完美坚持服用抗精神病药物与碰撞事故几率减半相关（调整后的优势比为0.50，95%置信区间为0.38 - 0.66）。在按性别、年龄以及酒精或药物滥用史定义的亚组中，研究结果一致。
更好地坚持服用抗精神病药物与较低的碰撞风险相关。医生和驾驶适宜性政策制定者可能会将抗精神病药物治疗的依从性视为精神分裂症患者维持有效驾驶执照的一个条件。
