Driving Ability under Sertindole

Abstract

Introduction:

Fitness to drive is an important prerequisite for the functional autonomy and thus also relevant for patients with a psychiatric illness. The efficacy of sertindole in the treatment of positive and negative schizophrenia symptoms has been shown in various studies. However, hitherto there exist no data about patients’ fitness to drive under sertindole.

Methods:

A non-randomized clinical study with 30 schizophrenic inpatients receiving sertindole (n=10), risperidone (n=10) or quetiapine (n=10) was conducted. Patients were tested under steady-state plasma level conditions prior to discharge to outpatient treatment. Data were collected with the computerized Act and React Testsystem (ART90) and the Wiener Determinationsgerät (WDG) measuring psychomotor skills relevant for fitness to drive.

Results:

The main findings of this study are (i) that about 26% of schizophrenic patients, ­following psychopathologic stabilization and prior discharge to outpatient treatment show severe impairments with respect to driving skills. (ii) Statistically significant differences between atypical antipsychotics could neither be demonstrated on the level of the global driving ability score nor on individual functional domains essential for fitness to drive.

Conclusion:

With respect to driving skills no differences have been found between patients treated with sertindole, risperidone or quetia­pine. However, a great proportion of schizophrenic patients partly remitted must be considered as unfit to drive, even when stabilized on treatment with atypical antipsychotics.

Key words

driving ability - antipsychotic drugs - schizophrenia

• References

• 1 Brunnauer A, Laux G, Zwick S et al. Mobility behaviour of patients with mental illness. Dtsch Z Nervenheilkd 2008; 27: 120-121
• 2 Palmer BW, Heaton RK, Gladsjo JA et al. Heterogeneity in functional status among older outpatients with schizophrenia: employment history, living situation, and driving. Schizophr Res 2002; 55: 205-215
• 3 Charlton JL, Koppel S, O’Hare M et al. Influence of chronic illness on crash involvement of motor vehicle drivers. Monash Accident Research Centre Report, Swedish National Road Administration. 2004
• 4 Edlund MJ, Conrad C, Morris P. Accidents among schizophrenic outpatients. Compr Psychiatry 1989; 30: 522-526
• 5 Elkem RC, Bronssean J, Koshnick R et al. A statistical study on the relationship between mental illness and traffic accidents – a pilot study. Am J Public Health 1970; 60: 459-469
• 6 Waller JA. Chronic medical conditions and traffic safety: a review of the California experience. N Engl J Med 1965; 273: 1413-1420
• 7 Hambrecht M, Lammertink M, Klosterkötter J et al. Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic. Br J Psychiatry 2002; 43: 30-37
• 8 Velligan DI, Miller AL. Cognitive dysfunction in schizophrenia and its importance to outcome: the place of atypical antipsychotics in treatment. J Clin Psychiatry 1999; 60 (Suppl. 23) 25-28
• 9 Leucht S, Pitschel-Walz G, Abraham D et al. Efficacy and extrapyramidal side-effects of the new antipsychotic olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized, controlled trials. Schi­zophr Res 1999; 35: 51-68
• 10 Soyka M, Winter C, Kagerer S et al. Effects of haloperidol and risperidone on psychomotor performance relevant to driving ability in schizophrenic patients compared to healthy controls. J Psychiatr Res 2005; 39: 101-108
• 11 Brunnauer A, Laux G, Zwick S. Driving simulator performance and psychomotor functions of schizophrenic patients treated with anti­psychotics. Eur Arch Psychiatry Clin Neurosci 2009; 259: 483-489
• 12 Brunnauer A, Laux G, Geiger E et al. The impact of antipsychotics on psychomotor performance with regards to car driving skills. J Clin Psychopharmacol 2004; 24: 155-160
• 13 Grabe HJ, Wolf T, Gratz S et al. The influence of clozapine and typical neuroleptics on information processing of the central nervous system under clinical conditions in schizophrenic disorders: implications for fitness to drive. Neuropsychobiology 1999; 40: 196-201
• 14 Brunnauer A, Geiger E, Laux G et al. Fahrsimulation und psychomotorische Leistungsfähigkeit schizophrener Patienten. Psychopharmakotherap 2005; 12: 91-96
• 15 Dittert S, Soyka M, Winter C et al. Cognition and driving in schizophrenic patients under treatment with risperidone vs. haloperidol. Fortschr Neurol Psychiatr Suppl 1999; 2: 70-73
• 16 Kagerer S, Winter C, Moeller HJ et al. Effects of haloperidol and atypical neuroleptics on psychomotor performance and driving ability in schizophrenic patients. Results from an experimental study. Neuropsychobiology 2003; 47: 212-218
• 17 Gallhofer B, Jaanson P, Mittoux A et al. Course of recovery of cognitive impairment in patients with schizophrenia: a randomised double-blind study comparing sertindole and haloperidol. Pharmacopsychiatry 2007; 40: 275-286
• 18 Kivircik Akdede BB, Alptekin K, Kitis A et al. Effects of quetiapine on cognitive functions in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29: 233-238
• 19 Kopala LC, Good KP, Milliken H et al. Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes. Schizophr Res 2006; 81: 29-39
• 20 Riedel M, Spellman I, Strassnig M et al. Effects of risperidone and quetiapine on cognition in patients with schizophrenia and predominantly negative symptoms. Eur Arch Psychiatry Clin Neurosci 2007; 257: 360-370
• 21 Sax KW, Strakowski SM, Keck Jr PE. Attentional improvement following quetiapine fumarate treatment in schizophrenia. Schizophr Res 1998; 33: 151-155
• 22 Houthhoofd SAMK, Morrens M, Sabbe BGC. Cognitive and psychomotor effects of risperidone in schizophrenia and schizoaffective disorder. Clin Ther 2008; 30: 1565-1589
• 23 Menard I, Korner-Bitensky N, Dobbs B et al. Canadian psychiatrists’ current attitudes, practices, and knowledge regarding fitness to drive in individuals with mental illness: a cross-Canada survey. Can J Psychiatry 2006; 51: 836-884