Mental Health Flashcards
Is the mental health guideline discretionary or non-discretionary?
discretionary
Lack of impulse control is a characteristic of what type of mental disorder?
Personality disorder
What aspects of mental health must be intact in order for a person to be a safe driver?
Impulse control, including degree of risk-taking
information processing
judgment, including ability to predict and anticipate
memory
problem solving(executive functioning) including ability to respond to spinal tinea stimuli in a changing environment
reasoning
sustained attention
visual - spatial functioning
What is the regulation that addresses mental health of commercial drivers? What does it say?
Standard 49 CFR 391.41 (b)(9)
does a driver should have no mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with the driver’s ability to drive a commercial motor vehicle safely.
What are three categories for which recommendations have been made by a panel for the Conference on Psychiatric Disorders and Commercial Drivers ?
- Mental disorders-includes symptoms/disturbances that compose hazards for driving
- Residual symptoms - occur after time-limited reversible episodes or initial presentation of the full syndrome; the residual symptoms can interfere with safe driving.
- Psychopharmacology: some psychotropic medications can compromise performance to the degree that driving a commercial motor vehicle would be hazardous.
Describe the categories of mental disorders.
- Psychotic disorders
- Personality disorders
- Mood disorders
-manic
-depressive
Describe characteristics of psychotic disorders.
-Delusions/hallucinations (psychosis)
-inappropriate behavior
-inability to think clearly
-poor judgment
-unable to respond emotionally
-unpredictable behavior
Describe characteristics of personality disorders.
-Exacerbate with stress
-inability to cope
-inaccurate perception of the world
-inflexible and maladaptive behaviors
-lack of impulse control
Describe characteristics of mood disorders.
- Mania
-aggressive, grandiose
-increased energy, impulsive, inflated self-esteem
-irritable
-poor judgment, racing thoughts - Depression
-change in appetite, feels worthless
-lack of energy, poor judgment
-slow reaction time
-suicidal thoughts and behaviors
When a driver has a diagnosis of schizophrenia or a related disorder, what are important considerations regarding certification?
-Risk of suicide
-medication side effects that interfere with safe driving
-schizophrenia is usually disqualifying
If a driver is diagnosed with brief reactive psychosis or schizophrenia form disorder, what is the minimum required waiting period?
Waiting period is six months symptom-free
If a driver is diagnosed with a psychotic disorder other than brief reactive psychosis or schizophrenia form disorder, what is the minimum required waiting period?
Waiting period is one year symptom-free
A certified driver must report any manic or severe depressive episode and seek medical intervention within 30 days of the episode.
What two specific psychotic disorders automatically disqualify a driver from certification?
-schizophrenia
-active psychosis
What requirements must a driver with a diagnosis of a psychotic disorder meet in order to be certified?
-Complies with treatment program
-tolerates treatment without side effects that would pose a risk to public safety
-comprehensive evaluation from mental health professional
What would cause a driver with a psychotic disorder to be disqualified?
-Diagnosis of schizophrenia or active psychosis
-treatment side effects pose a risk to public safety
-prominent negative symptoms: compromise judgment, difficulty paying attention, suicidal behavior/mediation, or personality disorder manifested by repeated overt inappropriate acts
What is the maximum certification period allowed for a driver with a psychotic disorder?
-One year
again, a driver with a diagnosis of schizophrenia or active psychosis is ineligible for certification
What kind of follow-up is required for driver with a psychotic disorder?
-maximum certification for one year
-clearance from mental health specialist every two years
-annual medical exam
What is cyclothymia?
It is a mild form of bipolar disorder that causes brief episodes of depression or elevated mood, but doesn’t cause marked impairment. Treatment may include medication.
Suppose a driver with diagnosis of bipolar disorder has nonpsychotic major depression without suicidal behavior. What is the minimum waiting period for this driver?
waiting period is six months symptom-free
Suppose a driver with diagnosis of bipolar disorder has a severe depressive episode, suicide attempt, or a manic episode. What is the minimum waiting period for this driver?
waiting period is one year symptom-free
Under what circumstances can a driver with a diagnosis of bipolar mood disorder be certified?
-complies with treatment
-tolerates treatment without side effects that pose a risk to public safety
-comprehensive evaluation from appropriate mental health professional
What is the maximum certification period for a driver with diagnosis of bipolar mood disorder?
-Maximum certification is one year
-must have clearance from a mental health professional at least every two years
Under what circumstances is a driver with a diagnosis of bipolar mood disorder ineligible to be certified?
-Active psychosis
-prominent negative symptoms such as compromise judgment, difficulty paying attention, suicidal behavior/ideation, personality disorder manifested by repeated overt inappropriate acts
-treatment side effects pose a risk to public safety
Regarding depression, highest risk of suicide is when?
first few years of onset
Under what circumstances can a driver with a personality disorder receive certification?
-Etiology is confirmed
-treatment is safe and effective; driver complies with treatment
-driver tolerates treatment without side effects that would pose a risk to public safety
-comprehensive evaluation from a mental health professional
Under what circumstances is a driver with the personality disorder ineligible for certification?
-Active psychosis
-prominent negative symptoms such as compromise judgment, difficulty paying attention, suicidal behavior/ideation, personality disorder manifested by repeated overt inappropriate acts
-treatment side effects pose a risk to public safety
If a driver with personality disorder receives certification, what is the maximum certification.?
Maximum certification is for one year
If a driver with personality disorder receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-Must have an annual medical exam
-determine additional testing and consult with a mental health professional on a case-by-case basis
A significant percentage of individuals with adult ADHD show moderate to marked improvement on what kind of medication?
Central nervous system stimulant medication
Which condition may experience enhanced driving ability while using a central nervous system stimulant?
ADHD
When is a driver with a diagnosis of ADHD eligible for certification?
-etiology is confirmed
-treatment is safe and effective; driver complies with treatment
-driver tolerates treatment without side effects that would pose a risk to public safety
-comprehensive evaluation from a mental health professional
If a driver with a diagnosis of ADHD receives certification, what is the maximum certification period ?
one year
If a driver with ADHD receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-annual medical exam
-additional tests on a case by case basis
-maximum certification period is for one year
Under what circumstances is a driver with a diagnosis of ADHD ineligible for certification?
-Cannot be certified until etiology is confirmed
-treatment is not effective
-treatment side effects pose a risk to public safety
-prominent negative symptoms such as compromise judgment, difficulty paying attention, suicidal behavior/ideation, personality disorder manifested by repeated overt inappropriate acts
When is a driver with a diagnosis of anxiety disorder eligible for certification?
-Treatment is shown to be safe and effective
-takes a hypnotic that is short-acting (meaning half-life of less than five hours), at the lowest dose, used for less than two weeks
-non-sedating anxiolytic
If a driver with a diagnosis of anxiety disorder receives certification, what is the maximum certification period ?
-Maximum certification period is for two years
-driver must have a biennial medical exam
If a driver with anxiety disorder receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-Driver must be examined every two years
-additional tests can be ordered on a case-by-case basis
Under what circumstances is a driver with a diagnosis of anxiety disorder ineligible for certification?
-Driver uses a sedating anxiolytic
-treatment side effects pose a risk to public safety
Antidepressants automatically disqualify a driver?
No. Assess on a case-by-case basis.
Name some first-generation antidepressants. What is important to remember about first-generation antidepressants?
-Examples:
amitriptyline (Elavil)
imipramine (Tofranil)
First-generation antidepressants interfere with safe driving.
What is important to know about second-generation antidepressants?
-Preferred to first-generation antidepressants
-fewer side effects; however, can still interfere with safe driving
-require case-by-case evaluation
Name some examples of selective serotonin reuptake inhibitors (SSRIs).
- escitalopram
- duloxetine
- fluoxetine
- sertraline
Name some examples of aminoketones.
bupropion
amfebutamone
budeprion
When is a driver with a diagnosis of depression eligible for certification?
-Treatment is safe and effective
-underlying condition does not interfere with safe driving
-tolerates treatment without side effects that pose a risk to public safety
If a driver with a diagnosis of depression receives certification, what is the maximum certification period ?
Maximum certification period is one year
If a driver with depression receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
- maximum certification for one year
- annual medical exam
- additional tests on a case-by-case basis
- consult with the specialists to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder
Under what circumstances is a driver with a diagnosis of depression ineligible for certification?
-Use of first-generation antidepressant
-Examples:
amitriptyline (Elavil)
imipramine (Tofranil)
-treatment side effects pose risk to public safety
guidelines suggest to not certify a driver who is taking a first-generation antidepressant. If you choose to do so, document your rationale on the medical exam form.
___________ is used mainly to treat bipolar disorder and depressive disorders. It shows little evidence of interfering with driving skills performance.
Lithium
When is a driver who takes lithium eligible for certification?
-Treatment is safe and effective
-asymptomatic
-no impairment that interferes with safe driving
-lithium levels are maintained in the therapeutic range
-driver undergoes regular follow-up by treating provider
If a driver who takes lithium receives certification, what is the maximum certification period ?
-max certification period is not defined
-annual medical exam req
-additional tests must be done on a case-by-case basis
-consult with mental health specialist to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder
If a driver who takes lithium is certified, with what frequency does this driver require a medical exam?
Must have an annual exam
Under what circumstances is a driver who takes lithium ineligible for certification?
-Disqualifying underlying condition
-disqualifying symptoms
-lithium levels are not in therapeutic range
Typical and atypical neuroleptics can be used to treat schizophrenia, psychotic mood disorders, and some personality disorders. Give two examples of these drugs.
-Abilify (aripiprazole)
-Zyprexa (olanzapine)
Typical and atypical neuroleptics are used to treat impulsiveness, perception and cognition disturbances, and inattention. Unfortunately, they often only partly control symptoms. Give two examples of these drugs.
-Abilify (aripiprazole)
-Zyprexa (olanzapine)
What are some side effects of neuroleptics that can interfere with driving?
- motor dysfunction
- decreased coordination
- increased response time
- sedation
- visual disturbances, especially at night
When is a driver who takes typical or atypical neuroleptics eligible for certification?
-Treatment is safe and effective for the driver
-underlying condition does not interfere with safe driving
-tolerates treatment without side effects oppose risk to public safety
If a driver who takes typical or atypical neuroleptics receives certification, what is the maximum certification period ?
-maximum certification period is one year
If a driver who takes typical or atypical neuroleptics receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-Annual medical exam required
-maximum certification for one year
-additional tests must be done on a case-by-case basis
-consult with mental health specialist to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder
Under what circumstances is a driver who takes typical or atypical neuroleptics ineligible for certification?
-Disqualifying underlying condition
-treatment side effects pose risk to public safety
Can a driver who is taking a central nervous system stimulant be certified?
-Usually, CNS stimulant usage is disqualifying
-under certain circumstances, stimulants are allowed if being used to treat ADHD, brain damage, or fatigue
-low doses of stimulants can enhance vigilance/attention; can enhance performance of simple tasks, but may not improve ability to complete complex intellectual functions
What should you do prior to qualifying a driver who is on CNS stimulants?
-Requests evaluation from treating provider
-verify diagnosis of ADHD
-use caution when determining side effects
When is a driver who takes CNS stimulants eligible for certification?
-Treatment is safe and effective for the driver
- nondisqualifying underlying condition (e.g. adult ADHD)
- no drug induced impairment
-no tendency to increase dose
If a driver who takes CNS stimulants receives certification, what is the maximum certification period ?
-Maximum certification is one year
If a driver who takes CNS stimulants receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-Must have an annual medical exam
-maximum certification period is one year
-consult with mental health specialist to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder
Under what circumstances is a driver who takes CNS stimulants ineligible for certification?
-In most cases, drivers taking CNS stimulants cannot be certified
-don’t certify if there is a disqualifying underlying condition such as narcolepsy
-don’t certify if they are treatment side effects that interfere with safe driving
What is a side effect of electroconvulsive therapy?
-Produces an acute organic mental syndrome characterized by confusion, disorientation, and short-term memory loss
When is a driver who has received ECT eligible for certification?
-Must complete six-month waiting period
-comprehensive evaluation from mental health specialist
-no maintenance ECT
-tolerates treatment without side effects which pose risk to public safety
What waiting period is required after a driver has received ECT?
Six-month waiting period
If a driver who has received ECT receives certification, what is the maximum certification period ?
Maximum certification period has not been specified.
Driver must have an annual medical exam
If a driver who has received ECT receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?
-Annual medical exam required
-consult with mental health specialist to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder
Under what circumstances is a driver who has received ECT ineligible for certification?
-Driver is receiving maintenance ECT
-side effects which pose risk to public safety
