Driving fitness in clinically stable outpatients with chronic schizophrenia.

INTRODUCTION: Driving motorized vehicles is an integral part of individual mobility and a key parameter for employment and social integration. This naturalistic, cross-sectional study investigated the associations between driving fitness, residual symptomatology, olanzapine equivalent, and extrapyramidal symptoms (EPS) in long term stable outpatients with schizophrenia. METHODS: Beside sociodemographic data, and driving habits, residual symptoms, and EPS were assessed using the Positive and Negative Syndrome Scale (PANSS), and the Modified Simpson Angus Scale (MSAS). PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. MSAS cut-off scores ≥3 were defined as positive for EPS. Driving skills were assessed using the Vienna Test System and an expert evaluation. RESULTS: 50 patients were included into the study. Mean PANSS total scores indicated mild residual symptomatology and EPS were not present in 48% of study participants. 44% passed the driving fitness assessment and were considered as competent to drive, 20% were judged to be partially competent and 36% to be incompetent to drive. With the exception of disorganization (r = -0·287, p = 0·048) residual symptoms of schizophrenia did not correlate with driving fitness. However, moderate negative correlations were detected between driving fitness and the severity of EPS (r = -0·554, p = 0·000), age (r = -0·413, p = 0·003) as well as olanzapine equivalent doses (r = -0·432, p = 0·002). These results were not corrected for multiple comparison. DISCUSSION: The present findings indicate that up to two thirds of clinically stable outpatients with chronic schizophrenia may be (partially) competent to drive. Both the presence of EPS as well as the dosage of antipsychotic medication seem to be of particular relevance in this regard.

Executive Dysfunctions Predict Self-Restricted Driving Habits in Elderly People with or without Alzheimer's Dementia.

Introduction The purpose of this study was to elucidate the impact of specific cognitive functions on self-restricted driving habits in healthy elderly drivers and patients suffering from mild cognitive impairment (MCI) and Alzheimer's dementia (AD). Method Our study population included 35 cognitively healthy controls, 10 MCI patients, and 16 patients with AD. All participants completed a neuropsychological examination and a self-reported questionnaire assessing driving habits and patterns. Results In challenging driving conditions, patients with MCI or AD showed significantly more driving self-restriction than healthy subjects (effect size d=1.06, p=0.007). Ordinal regression analysis across the entire group revealed that deficits in executive functions and reaction had a higher impact on driving restriction (p=0.002) than deficits in memory functions (p=0.570). Additionally, our data showed that 40% of patients with mild to moderate AD still drive in challenging conditions. Discussion Our results illustrate that elderly individuals use self-imposed driving restrictions as compensatory strategies. These restrictions increase with cognitive decline mainly in the field of executive functions, but they do not change once patients convert from MCI to AD.

Physician's Burnout and the COVID-19 Pandemic-A Nationwide Cross-Sectional Study in Austria.

Background: The current study assesses the prevalence of burnout and psychological distress among general practitioners and physicians of various specialities, who are not working in a hospital, during the COVID-19 pandemic. Additionally in this context, contributing factors are registered. Materials and Methods: Burnout and psychological distress were assessed with the Copenhagen Burnout Inventory (CBI) and the Brief Symptom Inventory (BSI-18). A newly developed self-reporting questionnaire was used to evaluate demographic data and pandemic-associated stress factors. Results: 252 general practitioners and 229 private practice physicians provided sufficient responses to the outcome variables for analysis. The prevalence of clinically relevant psychological distress was comparable between groups (12.4 vs. 9.2%). A larger proportion of general practitioners than specialists had intermediate (43.8 vs. 39.9%) or high burnout (26.9 vs. 22.0%) without reaching statistical significance for either category. When combining study participants with intermediate and high levels of burnout, the group difference attained significance (70.7 % vs. 61.9%). Conclusion: Our findings provide evidence that practicing physicians are at high risk of burnout in the context of the pandemic. Being single (standardized beta = 0.134), financial problems (beta = 0.136), and facing violence in patient care (beta = 0.135) were identified as significant predictors for psychological distress. Burnout was predicted by being single (beta = 0.112), financial problems (beta= 0.136), facing violence in patient care (beta = 0.093), stigmatization because of treatment of SARS-CoV-2-positive patients (beta = 0.150), and longer working hours during the pandemic (beta = 0.098).

[Burnout in physicians]. / Burnout-Symptomatik bei KlinikärztInnen.

BACKGROUND: Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. METHODS: A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. RESULTS: Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. CONCLUSION: Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

Trends in the pharmacological treatment of patients with schizophrenia over a 12 year observation period.

In this study we evaluated whether our efforts to promote evidence-based guidelines for the psychopharmacological treatment of patients with schizophrenia have led to measurable changes of treatment practice in our hospital by investigating three primary hypotheses: 1) Polypharmacy has become less common in recent years, 2) Conventional neuroleptics have been replaced by second generation antipsychotics; and 3) Dosing regimes have changed towards lower doses. We have therefore collected data from the clinical records of all in-patients with ICD-9/ICD-10 diagnoses of schizophrenia hospitalized at the Department of Psychiatry of the Medical University Innsbruck in the years 1989, 1995, 1998 and 2001. Data from 1989 to 1998 showed a significant decrease in the use of two or more antipsychotics given simultaneously. Contrary to our hypothesis, there was a significant increase in polypharmacy between 1998 and 2001. The predominant use of second generation antipsychotics became standard in schizophrenia treatment. In this context the decrease of concomitant anticholinergic medication is notable. Doses of conventional antipsychotics like haloperidol as well as doses of risperidone decreased whereas doses of other second generation antipsychotics increased. All in all, the pharmacological management of schizophrenia patients is increasingly in tune with current treatment guidelines.

Alcohol and benzodiazepines in falls: an epidemiological view.

Falls are common at all ages and especially in the elderly; it is important to understand contributing causes. Over a 1-year period we studied blood alcohol (BAC) and benzodiazepine concentrations in patients attending an emergency department because of a fall. The 22% of 615 patients tested were positive for alcohol, 55% were positive for benzodiazepines (BZD) and 1.5% were positive for both substances. A significantly larger proportion of males tested positive for alcohol (40.2%) than females (7.6%). Both in males and females the percentage as well as the extent of blood alcohol levels decreased significantly with age. Benzodiazepines were also consumed more frequently in males (8.5%) than in females (3.2%, p=0.007). Concerning BAC there was no difference between males (1.75+/-0.81 g/l) and females (1.66+/-0.91 g/l). In patients older than 70 years the BAC (1.30+/-0.80 g/l) was lower in comparison to younger ones. All blood samples positive for benzodiazepines could be traced back to diazepam consumption. We found a high number of young and middle aged patients using alcohol (males=49.7%; females=18.9%) and a lower but still relevant number of benzodiazepine users (males=9.5%; females=2.4%). In addition, this study shows that alcohol plays a more important role in patients up to 70 years in fall-related accidents when compared to accidents of other causes.

Attitudes of patients with schizophrenia toward placebo-controlled clinical trials.

BACKGROUND: Despite the fact that the efficacy of antipsychotic treatment in patients with schizophrenia has been demonstrated in numerous double-blind studies, placebo-controlled studies are still commonly performed. Although much is known about the opinions of professionals concerning this issue, so far nothing is known about the opinions of patients who are most affected by the realization of placebo-controlled clinical trials. METHOD: In a cross-sectional study from June 2000 to January 2001, 100 inpatients and outpatients with ICD-10 schizophrenia or schizophreniform disorder were investigated by using a questionnaire specifically developed to survey patients' attitudes concerning possible participation in placebo-controlled clinical trials. Psychopathology and side effects were physician-rated. RESULTS: 56% of patients would not be willing to participate in a placebo-controlled clinical trial. On the other hand, only about 16% of the patients are against clinical trials in principle. Gender, treatment, severity of psychopathology (Positive and Negative Syndrome Scale), adverse events (UKU Side Effect Rating Scale), and attitude toward medication (Drug Attitude Inventory) had no statistically significant influence on the decision. Most of the patients (76%) stated that they would not lose trust in their physician if asked to participate in a placebo-controlled clinical trial. CONCLUSION: The opinions and fears of patients who are most affected by the debate need to be considered when deciding whether a placebo-controlled clinical trial is necessary.

Special gender issues in psychiatry.

Significant gender differences exist in the course, manifestation and treatment of mental illness. Regardless of specific diagnosis age is one of the key factors in gender differences. Such differences between the sexes exist not only concerning origin and perpetuation of specific psychiatric diseases, they are also available and notable in specific fields of pharmacological and psychotherapeutically treatment. That review should sensitize clinicians for their responsibility to provide individualized, optimally effective, gender-specific care to patients suffering from mental diseases in some special topics. It should be a short overview considering some important gender details illustrated in concern with the epidemiological background, the symptoms and general used psychiatric treatment strategies of some frequent psychiatric diagnoses.

The effect of nabilone on neuropsychological functions related to driving ability: an extended case series.

The primary goal of this prospective extended case series was to obtain the first data about the potential influence of nabilone intake on driving ability related neuropsychological functions. Six patients were investigated within a placebo controlled, double-blind crossover study of this synthetic cannabinoid (2 mg/day) in patients with multiple sclerosis and spasticity associated pain. Five neuropsychological functions (reaction time, working memory, divided attention, psychomotor speed and mental flexibility) were assessed. No indication was found of a deterioration of any of the five investigated neuropsychological functions during the 4-week treatment period with nabilone.

Alcohol and/or benzodiazepine use: different accidents--different impacts?

1611 patients were included in this investigation. 16.7% of the patients were involved in traffic accidents, 38.2% were injured by a sudden fall, 3.5% were involved in an act of violence, 22.8% were injured by a sports related accident and 18.9% were hurt within a work-related accident. 19.5% of the patients tested positive for alcohol, 5.2% tested positive for benzodiazepines and 1.4% tested positive for both substances. Blood samples were positive for alcohol in 27% males and 7.7% females and for benzodiazepines in 6.3% males and in 3.5% females. The mean blood alcohol concentration (BAC) as well as the mean benzodiazepine plasma level were higher in patients injured in violent accidents compared to the other injury groups. This study provides epidemiologic information about the relationship between specific kinds of accidents and alcohol and/or benzodiazepine use in a large probability sample of emergency room patients. We found a high number of patients using alcohol, and a lower but still relavant number of benzodiazepine users in this large and unselected traumatology ER sample. This study adds evidence to the existing literature about the co-occurance of alcohol and/or benzodiazepine consumption and accident-related injuries.

The safety of clozapine in the treatment of first- and multiple-episode patients with treatment-resistant schizophrenia.

The importance of antipsychotics in the treatment of schizophrenia has been documented in numerous clinical trials. In addition to its established superiority over other antipsychotics in treatment-resistant patients, clozapine has been consistently shown to improve psychopathology and other psychosocial outcome variables in patients with schizophrenia. To determine whether the course of the illness has an influence on response and side-effects to clozapine, we directly contrasted first- and multiple-episode patients with schizophrenia, who had histories of failing response to traditional antipsychotics, during the acute treatment phase. Thirty-nine first-episode patients with schizophrenia and 56 patients who had suffered from at least two episodes of this illness were investigated. Severity of illness and clinical improvement were rated by means of the CGI Scale. Vital signs were recorded weekly. Side-effects were regularly assessed with the UKU Side Effect Rating Scale. Compliance was regularly assessed by clinical interviews and plasma level monitoring. By using comparable mean clozapine doses, the number of treatment responders was similar in both groups (first-episode patients, 51.3%; multiple-episode patients, 46.4%). However, we found a negative association between age and response rate. With regard to side-effects, we could not find any significant difference between groups. Altogether, response and side-effects to clozapine treatment do not seem to be determined by the chronicity of the disorder.

[The role of alcohol and/or benzodiazepines in occupational accidents compared to accidents due to other causes]. / Alkohol--und/oder Benzodiazepinkonsum bei Arbeitsunfällen im Vergleich zu Unfällen anderer Genese.

All patients who were admitted within one year to the Department of Traumatology of the Innsbruck University Hospital as a result of an accident were included in this epidemiological study: a total of 1611 patients. 18.9% (n = 304) of these patients were injured as a result of a work-related accident and the remaining 81.2% (n = 1307) were involved in accidents due to other causes. Within the group of patients involved in work-related accidents, alcohol consumption was more frequent in males (13.3%) than in females (1.8%) (p = 0.016) and clearly lower than in patients injured by accidents due to other causes. In work--related accidents we found a correlation between the educational standard of patients and the frequency of alcohol consumption. The mean blood alcohol concentration was lower in patients involved in work-related accidents (0.76 +/- 0.58 g/l) compared to other injuries (1.63 g/l +/- 0.74 g/l). No correlations were found concerning benzodiazepine use and demographic variables and all measured benzodiazepine plasma levels were within the therapeutic range.

Alcohol and/or benzodiazepine use in injured road users.

Blood samples of all patients (269) involved in a traffic accident and admitted to the Emergency Room of the University Hospital of Trauma Surgery in Innsbruck were analysed for alcohol and benzodiazepines. The large majority were drivers (55%) followed by passengers (19.7%), cyclists (12.6%) and pedestrians (12.3%). Alcohol was obviously the most commonly found drug in all groups (drivers: 36.9%; passengers: 15.1%; cyclists: 29.4%; pedestrians: 18.2%), with a mean BAC (blood alcohol concentration) high above the legal limit at the time of the study in Austria of 0.8 g/l (drivers: 1.49 +/- 54 g/l; passengers: 1.52 +/- 71 g/l; cyclists: 1.72 +/- 51 g/l; pedestrians: 1.67 +/- 25 g/l). The percentage of alcohol users was highest in drivers. Concerning BAC levels no significant differences were found between the groups. The most commonly detected benzodiazepine was diazepam. Benzodiazepine consumption (drivers: 8.1%; passengers: 5.7%; cyclists: 8.8%; pedestrians: 3%) as well as plasma levels (drivers: 68.7 +/- 62.6 microg/l; passengers: 61.0 +/- 69.3 microg/l; cyclists: 135.7 +/- 118.3 microg/l; pedestrians: 18 microg/l) were nearly equal in all groups. Concerning alcohol or benzodiazepine use, females showed lower frequencies of both alcohol and benzodiazepine positive blood samples. The frequency of alcohol use was higher in patients