Cognitive Skills Underlying Driving in Patients Discharged Following Self-Poisoning With Central Nervous System Depressant Drugs
Cognitive Skills Underlying Driving in Patients Discharged Following Self-Poisoning With Central Nervous System Depressant Drugs
复制标题
DOI：
10.1080/15389588.2012.671983
复制
发表时间：
2012-01-01
影响因子：
2
通讯作者：
Carter, Gregory L.
中科院分区：
文献类型：
--
作者：
Dassanayake, Tharaka L.;Michie, Patricia T.;Carter, Gregory L.
背景：中枢神经系统抑制剂（CNS-D）药物会损害认知功能和驾驶能力。它们也是在医院治疗的自中毒事件中最常见的过量服用药物。在澳大利亚，大多数患者在 48 小时内出院，但他们仍然可能存在亚临床药物效应。我们的目的是确定接受 CNS-D 自我中毒治疗的患者在 Trail-Making Test（TMT，A 和 B 部分）中是否受到损害，这是一种已知与驾驶表现相关的神经心理学测试。 方法：这项研究于 2008 年 11 月至 2011 年 4 月在澳大利亚新南威尔士州的中毒转诊中心进行。 107 名因 CNS-D（苯二氮卓类药物、非典型抗精神病药或阿片类药物）自我中毒治疗后从临床毒理学科出院的患者和 68 名因非 CNS 抑郁药物（对乙酰氨基酚或非镇静抗抑郁药）自我中毒而出院的对照组接受了 TMT（A 部分和 B 部分）测试。由于众所周知，TMT 受损与驾驶障碍和交通事故风险增加有关，因此年龄低于第 10 个百分位的表现被定义为 TMT 各部分均存在显着受损。每个部位损伤的比值比 (OR) 是在根据性别、教育程度、智商和是否存在重大精神疾病进行调整的多元逻辑回归 (MLR) 模型中计算的。仅对那些直接出院回家的患者（78 名 CNS-D 和 54 名对照组参与者）进行二次 MLR 分析，排除那些转院接受进一步精神护理的患者。结果：CNS-D 组在 TMT-A 上出现损伤的几率是对照组的 2.8 倍（38 例 [35.5%] 对比 11 例 [16.2%]：调整后 OR = 2.76，95% 置信度间隔 [CI]：1.28-5.97），TMT-B 的 4.6 倍（67 [62.6%] 与 22 [32.4%]：调整后 OR=4.63，95% CI：2.06-10.42）。出院回家患者亚组的结果相似，CNS-D 组的 TMT-A 损伤几率是对照组的 3.3 倍（25 例 [32.1%] 对比 7 例 [13.0%]：调整后 OR = 3.30，95% CI：1.28-8.52），TMT-B 组损伤几率是对照组的 3.6 倍（46 例 [59.0%] 对比 7 例 [13.0%]：调整后 OR = 3.30，95% CI：1.28-8.52）。 17 [31.5%]：调整后 OR = 3.64，95% CI：1.44-9.20）。即使在调整 TMT-A 表现后，CNS-D 组的 TMT-B 损伤仍然显着。结论：CNS-D 过量用药的患者在出院时可能会出现驾驶认知技能的显着损伤。临床医生应警告这些患者，即使他们被认为临床已康复，他们的驾驶技能可能仍会受到损害，并建议他们在出院后的前 1 至 2 天内不要开车。
Background: Central nervous system-depressant (CNS-Ds) drugs can impair cognitive functions and driving. They are also the most common drugs taken in overdose in hospital-treated episodes of self-poisoning. In Australia most of these patients are discharged within 48 h, while they still have possible subclinical drug effects. We aimed to determine whether patients treated for self-poisoning with CNS-Ds are impaired in the Trail-Making Test (TMT, parts A and B), a neuropsychological test that is known to correlate with driving performance.Methods: This study was a conducted from November 2008 to April 2011 in a referral center for poisonings in New South Wales, Australia. One hundred seven patients discharged from the clinical toxicology unit following treatment for self-poisoning of CNS-Ds (benzodiazepines, atypical antipsychotics, or opioids) and a control group of 68 discharged following self-poisoning of non-CNS-depressant drugs (acetaminophen or nonsedating antidepressants) were tested with the TMT (parts A and B). Due to the known association of impaired TMT with driving impairment and increased risk of traffic accidents, performance less than the 10th percentile for age was defined as significant impairment in each part of the TMT. The odds ratio (OR) for impairment in each part was calculated in multivariate logistic regression (MLR) models adjusted for gender, education, IQ, and the presence of a major psychiatric illness. A secondary MLR analysis was conducted only for those patients (78 CNS-D and 54 control group participants) who were directly discharged home, after excluding those who were transferred for further psychiatric care.Results: The odds of impairment in the CNS-D group was 2.8 times that of the control group on the TMT-A (38 [35.5%] vs. 11 [16.2%]: adjusted OR = 2.76, 95% confidence interval [CI]: 1.28-5.97), and 4.6 times on the TMT-B (67 [62.6%] vs. 22 [32.4%]: adjusted OR=4.63, 95% CI: 2.06-10.42). The results were similar in the subgroup of patients discharged home, and the odds of impairment in the CNS-D group was 3.3 times that of the control group on the TMT-A (25 [32.1%] vs. 7 [13.0%]: adjusted OR = 3.30, 95% CI: 1.28-8.52), and 3.6 times on the TMT-B (46 [59.0%] vs. 17 [31.5%]: adjusted OR = 3.64, 95% CI: 1.44-9.20). TMT-B impairment in the CNS-D group remained significant even after adjusting for TMT-A performance.Conclusions: Patients with CNS-D overdose may have significant impairment in cognitive skills underlying driving at the time of discharge from hospitals. Clinicians should warn these patients that their driving skills might still be impaired, even if they are considered clinically recovered and advise them not to drive during the first 1 to 2 days following discharge.