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DOT Exam Oakstone Course > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Is the mental health guideline discretionary or non-discretionary?

A

discretionary

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2
Q

Lack of impulse control is a characteristic of what type of mental disorder?

A

Personality disorder

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3
Q

What aspects of mental health must be intact in order for a person to be a safe driver?

A

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

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4
Q

What is the regulation that addresses mental health of commercial drivers? What does it say?

A

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.

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5
Q

What are three categories for which recommendations have been made by a panel for the Conference on Psychiatric Disorders and Commercial Drivers ?

A
  1. Mental disorders-includes symptoms/disturbances that compose hazards for driving
  2. Residual symptoms - occur after time-limited reversible episodes or initial presentation of the full syndrome; the residual symptoms can interfere with safe driving.
  3. Psychopharmacology: some psychotropic medications can compromise performance to the degree that driving a commercial motor vehicle would be hazardous.
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6
Q

Describe the categories of mental disorders.

A
  1. Psychotic disorders
  2. Personality disorders
  3. Mood disorders
    -manic
    -depressive
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7
Q

Describe characteristics of psychotic disorders.

A

-Delusions/hallucinations (psychosis)
-inappropriate behavior
-inability to think clearly
-poor judgment
-unable to respond emotionally
-unpredictable behavior

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8
Q

Describe characteristics of personality disorders.

A

-Exacerbate with stress
-inability to cope
-inaccurate perception of the world
-inflexible and maladaptive behaviors
-lack of impulse control

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9
Q

Describe characteristics of mood disorders.

A
  1. Mania
    -aggressive, grandiose
    -increased energy, impulsive, inflated self-esteem
    -irritable
    -poor judgment, racing thoughts
  2. Depression
    -change in appetite, feels worthless
    -lack of energy, poor judgment
    -slow reaction time
    -suicidal thoughts and behaviors
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10
Q

When a driver has a diagnosis of schizophrenia or a related disorder, what are important considerations regarding certification?

A

-Risk of suicide
-medication side effects that interfere with safe driving
-schizophrenia is usually disqualifying

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11
Q

If a driver is diagnosed with brief reactive psychosis or schizophrenia form disorder, what is the minimum required waiting period?

A

Waiting period is six months symptom-free

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12
Q

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?

A

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.

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13
Q

What two specific psychotic disorders automatically disqualify a driver from certification?

A

-schizophrenia
-active psychosis

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14
Q

What requirements must a driver with a diagnosis of a psychotic disorder meet in order to be certified?

A

-Complies with treatment program
-tolerates treatment without side effects that would pose a risk to public safety
-comprehensive evaluation from mental health professional

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15
Q

What would cause a driver with a psychotic disorder to be disqualified?

A

-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

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16
Q

What is the maximum certification period allowed for a driver with a psychotic disorder?

A

-One year
again, a driver with a diagnosis of schizophrenia or active psychosis is ineligible for certification

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17
Q

What kind of follow-up is required for driver with a psychotic disorder?

A

-maximum certification for one year
-clearance from mental health specialist every two years
-annual medical exam

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18
Q

What is cyclothymia?

A

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.

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19
Q

Suppose a driver with diagnosis of bipolar disorder has nonpsychotic major depression without suicidal behavior. What is the minimum waiting period for this driver?

A

waiting period is six months symptom-free

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20
Q

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?

A

waiting period is one year symptom-free

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21
Q

Under what circumstances can a driver with a diagnosis of bipolar mood disorder be certified?

A

-complies with treatment
-tolerates treatment without side effects that pose a risk to public safety
-comprehensive evaluation from appropriate mental health professional

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22
Q

What is the maximum certification period for a driver with diagnosis of bipolar mood disorder?

A

-Maximum certification is one year
-must have clearance from a mental health professional at least every two years

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23
Q

Under what circumstances is a driver with a diagnosis of bipolar mood disorder ineligible to be certified?

A

-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

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24
Q

Regarding depression, highest risk of suicide is when?

A

first few years of onset

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25
Q

Under what circumstances can a driver with a personality disorder receive certification?

A

-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

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26
Q

Under what circumstances is a driver with the personality disorder ineligible for certification?

A

-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

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27
Q

If a driver with personality disorder receives certification, what is the maximum certification.?

A

Maximum certification is for one year

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28
Q

If a driver with personality disorder receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?

A

-Must have an annual medical exam

-determine additional testing and consult with a mental health professional on a case-by-case basis

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29
Q

A significant percentage of individuals with adult ADHD show moderate to marked improvement on what kind of medication?

A

Central nervous system stimulant medication

30
Q

Which condition may experience enhanced driving ability while using a central nervous system stimulant?

A

ADHD

31
Q

When is a driver with a diagnosis of ADHD eligible for certification?

A

-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

32
Q

If a driver with a diagnosis of ADHD receives certification, what is the maximum certification period ?

A

one year

33
Q

If a driver with ADHD receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?

A

-annual medical exam
-additional tests on a case by case basis
-maximum certification period is for one year

34
Q

Under what circumstances is a driver with a diagnosis of ADHD ineligible for certification?

A

-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

35
Q

When is a driver with a diagnosis of anxiety disorder eligible for certification?

A

-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

36
Q

If a driver with a diagnosis of anxiety disorder receives certification, what is the maximum certification period ?

A

-Maximum certification period is for two years
-driver must have a biennial medical exam

37
Q

If a driver with anxiety disorder receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?

A

-Driver must be examined every two years
-additional tests can be ordered on a case-by-case basis

38
Q

Under what circumstances is a driver with a diagnosis of anxiety disorder ineligible for certification?

A

-Driver uses a sedating anxiolytic
-treatment side effects pose a risk to public safety

39
Q

Antidepressants automatically disqualify a driver?

A

No. Assess on a case-by-case basis.

40
Q

Name some first-generation antidepressants. What is important to remember about first-generation antidepressants?

A

-Examples:
amitriptyline (Elavil)
imipramine (Tofranil)

First-generation antidepressants interfere with safe driving.

41
Q

What is important to know about second-generation antidepressants?

A

-Preferred to first-generation antidepressants
-fewer side effects; however, can still interfere with safe driving
-require case-by-case evaluation

42
Q

Name some examples of selective serotonin reuptake inhibitors (SSRIs).

A
  • escitalopram
  • duloxetine
  • fluoxetine
  • sertraline
43
Q

Name some examples of aminoketones.

A

bupropion
amfebutamone
budeprion

44
Q

When is a driver with a diagnosis of depression eligible for certification?

A

-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

45
Q

If a driver with a diagnosis of depression receives certification, what is the maximum certification period ?

A

Maximum certification period is one year

46
Q

If a driver with depression receives certification, with what frequency does this driver require a medical exam? What other follow-up is needed?

A
  • 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
47
Q

Under what circumstances is a driver with a diagnosis of depression ineligible for certification?

A

-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.

48
Q

___________ is used mainly to treat bipolar disorder and depressive disorders. It shows little evidence of interfering with driving skills performance.

A

Lithium

49
Q

When is a driver who takes lithium eligible for certification?

A

-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

50
Q

If a driver who takes lithium receives certification, what is the maximum certification period ?

A

-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

51
Q

If a driver who takes lithium is certified, with what frequency does this driver require a medical exam?

A

Must have an annual exam

52
Q

Under what circumstances is a driver who takes lithium ineligible for certification?

A

-Disqualifying underlying condition
-disqualifying symptoms
-lithium levels are not in therapeutic range

53
Q

Typical and atypical neuroleptics can be used to treat schizophrenia, psychotic mood disorders, and some personality disorders. Give two examples of these drugs.

A

-Abilify (aripiprazole)
-Zyprexa (olanzapine)

54
Q

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.

A

-Abilify (aripiprazole)
-Zyprexa (olanzapine)

55
Q

What are some side effects of neuroleptics that can interfere with driving?

A
  • motor dysfunction
  • decreased coordination
  • increased response time
  • sedation
  • visual disturbances, especially at night
56
Q

When is a driver who takes typical or atypical neuroleptics eligible for certification?

A

-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

57
Q

If a driver who takes typical or atypical neuroleptics receives certification, what is the maximum certification period ?

A

-maximum certification period is one year

58
Q

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?

A

-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

59
Q

Under what circumstances is a driver who takes typical or atypical neuroleptics ineligible for certification?

A

-Disqualifying underlying condition
-treatment side effects pose risk to public safety

60
Q

Can a driver who is taking a central nervous system stimulant be certified?

A

-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

61
Q

What should you do prior to qualifying a driver who is on CNS stimulants?

A

-Requests evaluation from treating provider
-verify diagnosis of ADHD
-use caution when determining side effects

62
Q

When is a driver who takes CNS stimulants eligible for certification?

A

-Treatment is safe and effective for the driver
- nondisqualifying underlying condition (e.g. adult ADHD)
- no drug induced impairment
-no tendency to increase dose

63
Q

If a driver who takes CNS stimulants receives certification, what is the maximum certification period ?

A

-Maximum certification is one year

64
Q

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?

A

-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

65
Q

Under what circumstances is a driver who takes CNS stimulants ineligible for certification?

A

-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

66
Q

What is a side effect of electroconvulsive therapy?

A

-Produces an acute organic mental syndrome characterized by confusion, disorientation, and short-term memory loss

67
Q

When is a driver who has received ECT eligible for certification?

A

-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

68
Q

What waiting period is required after a driver has received ECT?

A

Six-month waiting period

69
Q

If a driver who has received ECT receives certification, what is the maximum certification period ?

A

Maximum certification period has not been specified.

Driver must have an annual medical exam

70
Q

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?

A

-Annual medical exam required
-consult with mental health specialist to evaluate dose, plasma concentration, duration of drug therapy, and severity of underlying disorder

71
Q

Under what circumstances is a driver who has received ECT ineligible for certification?

A

-Driver is receiving maintenance ECT
-side effects which pose risk to public safety

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