Drivers with psychotic disorders: the last inpatient or specialized outpatient care prior to a motor vehicle accident death

PURPOSE: Psychotic disorders are often associated with impaired driving. This study analyses drivers with psychotic disorders killed in fatal motor vehicle accidents (FMVAs) in comparison to controls without psychiatric disorders. The focus was on last care contact prior to FMVA, survival time from last contact to FMVA and official causes of death among deceased drivers. MATERIAL AND METHODS: The study includes 94 drivers with psychotic disorders and their 146 matched controls without psychiatric disorders killed in FMVAs in Finland between 1990-2011. Drivers' survival time after their last inpatient or specialized outpatient care, the diagnostic category of the care, and official cause-of-death category were extracted from nationwide registers. Of drivers with psychotic disorders, 70.2% had died in FMVA within 6 months of their last care contact. Among drivers with psychotic disorders whose deaths were classified as suicide, the median survival time after their last contact was only 29 days. CONCLUSIONS: Deceased drivers with psychotic disorders were characterised by shorter survival time from their last healthcare contact to FMVA, and increased suicidality compared to controls without psychiatric disorders. Physicians should consider assessing fitness to drive in patients with psychotic disorders at every care contact, particularly when the visit concerns psychiatric problems. Driving bans exceeding six months and police notification should be carefully considered when evaluating fitness to drive in this high-risk group.