2010 BC Guide in Determining Fitness to Drive

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Chapter 19: Psychiatric DisordersBACKGROUND19.1 About psychiatric disordersThe Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 7 , published by theAmerican Psychiatric Association, contains a standard classification system of psychiatricdisorders for health care professionals in the United States and Canada. It classifies psychiatricdisorders by diagnostic category, based on five axes. The five axes, along with a summary of thediagnostic category for each, and some common disorders falling within each axis are providedin the table below.Psychiatric Disorders: Axes, Diagnostic Categories and Common Disorders(DSM-IV-TR, American Psychiatric Association, 2000)Axis Diagnostic Category ExamplesAxis I:Axis II:Axis III:Axis IV:Axis V:Clinical disorders, includingmajor mental disorders, aswell as developmental andlearning disordersPersonality disorders, as wellas mental retardationAcute medical conditionsand physical disordersPsychosocial andenvironmental factorscontributing to the disorderGlobal assessment ofFunctioningDelirium, dementia, and other cognitivedisordersSubstance related disordersMood disorders (major depressive disorder,bipolar disorders, dysthymia)Anxiety disordersAttention-Deficit/Hyperactivity DisorderSchizophreniaPersonality disorderso Borderline Personality Disordero Schizotypal Personality Disordero Anti-social Personality Disordero Narcissistic Personality DisorderDiseases of the nervous, circulatory,musculoskeletal, etc. systemsRelationship, social, educational, occupational,housing or financial problems may precipitateor aggravate a mental disorderA rating scale, from 0 to 100, used to report onimpairment due to psychiatric disorderThis chapter is concerned with Axis I and Axis II disorders. Axis III focuses on general medicalconditions. Those conditions with relevance to driving safety are addressed in other chapters of7 The most recent addition is the DSM-IV-TR, published in 2000. Publication of the DSM-V is expected in 2012.226
this manual. Axis IV addresses external factors that may impact an individual’s physical orpsychological health and are not addressed in this manual. Axis V, the Global Assessment ofFunctioning, is a 0 to 100 scale used for reporting a clinician’s judgment of an individual’s levelof psychological, social and occupational functioning in light of any impairment due topsychiatric disorders. A low score is a red flag for potential impairment of functions necessaryfor driving.Delirium, dementia, and other cognitive disorders (Axis I)The effects of delirium, dementia, and other cognitive disorders on driving are covered inChapter 27 of this Manual, Cognitive Impairment including Dementia.Substance-use disorders (Axis I)Substance-use disorders refer to the taking of a drug of abuse (including alcohol). Substancesinclude alcohol, amphetamines, cannabis, cocaine, hallucinogens, sedatives, hypnotics, andanxiolytics. The effects of drugs commonly prescribed for medical conditions are addressed inChapter 29, Psychotropic DrugsMood disorders - Major Depressive Disorder, Bipolar Disorder, Dysthymia (Axis I)Major Depressive Disorder (single episode or recurrent), Bipolar Disorders (Manic, Depressed,or Mixed types), and Dysthymic Disorder are collectively referred to as mood disorders.Major Depressive Disorder is characterized by one or more episodes of depressed mood or lossof interest in usual activities, as well as four additional symptoms of depression, with theepisodes lasting for two or more weeks. Additional symptoms of depression include: change in appetite sleep disturbances decreased energy or fatigue sense of worthlessness or guilt, and poor concentration or difficulty making decisions.Bipolar Disorder is characterized by one or more manic or mixed (manic and depression)episodes, with or without a history of major depression.Dysthymic Disorder is defined as a chronically depressed mood over a period of at least twoyears.227
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Ministry of Public Safety and Solic
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AcknowledgmentsResearcherBonnie M.
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Table of Contents (click on any ite
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11.7 Private and commercial drivers
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BACKGROUND ........................
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PART 1:BACKGROUND1
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Appendix 2: Excerpts from the MVA t
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Chapter 2: The Driver Fitness Progr
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for the exercise of discretion by O
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1. SCREENINGA driver disclosesa med
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2.3 Roles and responsibilitiesOSMV
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Medical practitionersMedical practi
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Chapter 3:Driver Fitness Program Pr
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Because of these limitations, OSMV
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Example: the temporary storage of i
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Motor functions (including sensorim
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an individual with poor contrast se
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3.5 Best informationDriver fitness
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Chapter 4: Introduction to the Poli
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3. DETERMINATIONFrom2. AssessmentAn
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Once identified, a DMER is mailed t
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5.3 Screening aging driversDefiniti
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5.5 Transient impairmentsDefinition
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Chapter 6: Assessment Policies and
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6.2 Assessments will only be reques
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6.4 Requesting specialist assessmen
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Policy6.5.1 If a case manager or ad
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Persistent and episodic impairments
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further assessment. Drivers who sco
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6.9.4 A case manager or adjudicator
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ASSESSMENT PROCEDURESCase manager o
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A driver fitness determination is a
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Policy rationaleBecause individuals
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7.5.3 Generally, an individual whos
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7.6.2 In particular, the case manag
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7.8.3 Whether an individual can com
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in order to be fit to drive, the ca
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has the judgment and willingness to
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Policy7.11.1 If a case manager or a
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(e) the medical condition results i
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7.12 Communicating a decisionPolicy
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7.13 Determination proceduresThe fo
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During the reconsideration, the adj
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8.3 Reconsideration proceduresThe f
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Chapter 9:Introduction to the Medic
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9.4 Medical condition chapter templ
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Private and commercial drivers who
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Chapter 11: Diabetes - Hypoglycemia
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PercentFigure 1 - Prevalence of Dia
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neuropathy, nephropathy, cardiovasc
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11.8 Private drivers with diabetes
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11.9 Commercial drivers with diabet
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RestrictionsRe-assessmentguidelines
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Policy rationaleSevere hypoglycemia
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11.12 Private drivers who have pers
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11.13 Commercial drivers who have a
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11.14 Commercial drivers who have a
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11.15 Commercial drivers who have p
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PART B - HYPOGLYCEMIA11a. Has the p
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Produce my glycemic log for my doct
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Deep-vein thrombosisDeep-vein throm
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Aneurysms less than 5 cm in diamete
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GUIDELINES12.6 Private and commerci
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12.7 Private drivers who have an an
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12.9 Commercial drivers who have an
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Chapter 13: Musculoskeletal Conditi
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ConditionType of drivingimpairment
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ConditionsRestrictionsRe-assessment
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14.3 Chronic renal disease and adve
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14.8 Private drivers with end-stage
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14.10 Private and commercial driver
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Level ofImpairmentMildlyImpairedMod
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15.8 Commercial drivers with modera
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15.10 Commercial drivers with sever
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Policy rationaleDrivers who require
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Chapter 16: Vestibular DisordersBAC
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One study identified that 32.5% of
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ConditionType ofdrivingimpairmentan
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Re-assessmentguidelinesPolicy ratio
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Individuals who have undergone valv
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Episodic impairmentThe potential ep
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GUIDELINES17.6 Policy rationaleThes
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17.9 Commercial drivers with corona
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17.11 Private drivers who have had
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17.15 Private drivers who have vent
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Page 229 and 230: 17.53 SyncopeSee the guidelines in
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Page 233 and 234: Chapter 18: Hearing LossBACKGROUND1
Page 235 and 236: GUIDELINES18.6 Private drivers with
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Page 239: PLEASE COMPLETE THE FOLLOWING: YES
Page 243 and 244: Negative symptoms are characterized
Page 245 and 246: Schizophrenia (Axis I)Schizophrenia
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Page 249 and 250: Suicidal ideationSuicidal ideation
Page 251 and 252: GUIDELINES19.6 Private and commerci
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Page 255 and 256: Cerebrovascular accidentCVAs are th
Page 257 and 258: ConditionType of drivingimpairment
Page 259 and 260: GUIDELINES20.6 Private and commerci
Page 261 and 262: Re-assessmentguidelinesPolicy ratio
Page 263 and 264: 20.9 Private drivers who have had s
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Page 267 and 268: Visual field impairment refers to a
Page 269 and 270: Right homonymous hemianopiaBinasal
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Page 275 and 276: GlaucomaApproximately 67 million pe
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Page 281 and 282: Policy rationaleretinopathy dependi
Page 283 and 284: Policy rationaleIndividuals with be
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21.17 Visual field impairmentsTypes
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21.18 Examination of visual functio
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VISUAL FIELD TEST (VFT)For drivers
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To the Driver:Under section 29 of t
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Please note:Goldman, Esterman and H
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Cardiac syncopeCardiac syncope refe
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22.7 Private drivers who have had a
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22.9 Private drivers with recurrent
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22.11 Commercial drivers who have h
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22.13 Commercial drivers with recur
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Chapter 23: Seizures and EpilepsyBA
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abnormal numbnesstingling and a cra
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23.10 Private drivers with single u
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23.12 Private drivers with epilepsy
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23.18 Commercial drivers with epile
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Level of disabilityor worsening of
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Parkinson’s diseaseThere is a sma
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25.2 Prevalence and incidence of tr
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Chapter 26: Intracranial TumoursBAC
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Some examples of compensatory mecha
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i. aphasia (language disturbance)ii
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27.2 Prevalence and incidence of co
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27.4 Effect of cognitive impairment
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Chapter 28: Sleep DisordersBACKGROU
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An immediate reduction in daytime s
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28.5 CompensationIndividuals with s
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OSMV determinationguidelines cont
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Policy rationaleThe general approac
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Chapter 29: Prescription and Over-T
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Examples of newer antihistamines in
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Stimulants (for ADHD)Examples of st
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AntiepilepticsIn general, individua
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Sedating EffectLowModerateHighTCAsd
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dizziness, andblurred or double vis
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30.2 Effect of general debility and
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Appendix 1: Glossary of TermsCommer
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Medical assessmentis any kind of as
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Transient impairmentmeans a tempora
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must cause to be issued to the appl
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(ii) cancel the person's driver's l
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Appendix 3: Aging DriversAbout agin
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Percentadults. The survey also foun
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Appendix 4: Licence ClassesThe tabl
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Appendix 5: Drafting and Approval P
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drivers, this means that BC commerc
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2010 BC Guide in Determining Fitness to Drive

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