Handbook of Driving Simulation for Engineering, Medicine, and Psychology

Psychiatric Disorders and Driving Performance

Author
Henry Moller, University of Toronto

Abstract
The Problem. This chapter discusses the continuum of driving performance in healthy individuals under adverse conditions and specific psychopathologies ranging from anxiety disorders to mood disorders, psychotic disorders, attention deficit hyperactivity disorder (ADHD), and personality disorders. Role of Driving Simulators. Driving simulators are being used in a number of domains in psychiatric research and practice: (1) design of experimental protocols addressing epidemiological findings related to driving safety for specific conditions in a controlled setting; (2) diagnostic use of simulators as baseline performance-based “probes” of neurocognitive function in untreated patients; (3) related to this, tracking of performance over a treatment period, i.e., in a clinical trial context; (4) assessment of safety and therapeutic effect of medications used to treat psychiatric illness with respect to psychomotor function; (5) medicolegal assessments of fitness-to-drive; and (6) skills training and rehabilitation. Key Results of Driving Simulator Studies. Skills training and phobia desensitization models have been shown to generalize to improved clinical outcome and on-road performance in anxiety disorders. Targeted training of strategy application and spatial navigation may improve frontal/executive impairments found in ADHD, and mood and psychotic disorders. Pharmacologic studies have been useful in the study of acute psychomotor and next-day sedative effects of psychotropics; generally, studies have demonstrated superiority of novel antidepressant and antipsychotic medication with respect to psychomotor function. Studies on use of stimulants in ADHD suggest improved short-term performance, however data on long-term effects are needed and trends related to multitasking while driving need to be taken into account. Scenarios, Dependent Variables, and Limitations. This chapter highlights a continuum-based model of “Type 1/Type 2” crash risk scenarios, related to underarousal versus overarousal of the human perceptual apparatus and low versus high presence states. In this model, “Type 1” crashes are provoked by excessively monotonous driving conditions resulting in perceptual disengagement and “Type 2” crashes occur under excessively complex driving conditions; the more variable, challenging, and stimulus-rich a scenario is, the greater the “Type 2” crash risk. Relevant variables include reaction time, braking accuracy, road position, which can be continuously monitored, and specific driving errors such as lane incursions and collisions. While scenario design may be modeled based on presumed functional impairments in specific psychiatric disorders, simulator models need to individualize platforms when testing complex scenarios assaying attentional and executive function or interpersonal aspects of driving such as road rage.

Keywords
Driving Simulator, Psychiatric Disorders, Traffic Safety, Anxiety Disorders, Mood Disorders, Psychotic Disorders, PTSD, ADHD, Road Rage

Key Points
• Psychiatric disorders frequently lead to functional impairments in activities of daily living, including driving.
• Due to the fluctuating severity of symptoms of many psychiatric illnesses, driving performance at one point in time is difficult to generalize.
• Relevant variables included reaction time (steering/braking), road position, speed, and specific errors (e.g., crashes/lane incursions).
• There is an emerging body of literature regarding the use of simulators to assess effects of medications used to treat psychiatric illness. Simulators may potentially be used to sequentially track psychomotor performance during a treatment period.
• There is evidence for the potential use of simulators in skills training and rehabilitation in neuropsychiatric conditions.
• Use of simulators in the context of psychiatric disorders should take into account driving conditions and mental states that are most likely related to driving errors (i.e., monotony versus high complexity/overarousal).

Key Readings
Biederman, J., Fried, R., Monuteaux, M. C., Reimer, B., Coughlin, J. F., Surman, C. B. et al. (2007). A laboratory driving simulation for assessment of driving behavior in adults with ADHD: A controlled study. Annals of General Psychiatry, 6, 4.

Moller, H. J., Shapiro, C. M., and Kayumov, L. (2006). Effects of psychotropics on driving performance. In M. Lader, D. P. Cardinali, & S. R. Pandi-Perumal (Eds.), Sleep and sleep disorders: Neuropsychopharmacological approach (pp. 121–125). Georgetown, TX: Landes Biosciences.

Moller, H. J. (2008). Neural correlates of “Absence” in interactive simulator protocols. Cyberpsychology and Behavior, 11(2), 181–187.

Ramaekers, J. G. (2003). Antidepressants and driver impairment: Empirical evidence from a standard on-the-road test. Journal of Clinical Psychiatry, 64(1), 20–29.

Silverstone, T. (1988). The influence of psychiatric disease and its treatment on driving performance. International Clinical Psychopharmacology, 3(Supplement 1), 59–66.

Walshe, D., Lewis, E., O’Sullivan, K., and Kim, S. I. (2005). Virtually driving: Are the driving environments “real enough” for exposure therapy with accident victims? Cyberpsychology and Behavior, 8(6), 532–537.