AbstractsMedical & Health Science

Professional Doctorate - Doctorate of Clinical and Health Psycholog (DClin&HealthPsych) Background: Hospital treated deliberate self-poisoning (DSP) has become a major concern for developed countries as 90% of all deliberate self-harm is DSP (Carroll, Metcalfe, & Gunnell, 2014). A major concern for hospital treated DSP is the capacity of individuals to perform daily activities, such as driving, after being medically discharged. One study found that, at discharge, individuals admitted to hospital for DSP with central nervous system non-depressant (CNS-ND) drugs outperformed those admitted for DSP with CNS-D drugs across several neuropsychological measures (Dassanayake, Michie, et al., 2012). A self-controlled case series that linked the New South Wales (NSW) Roads and Traffic Authority CrashLink database and the NSW Admitted Patient Data Collection from 2001–2008 found that patients were at increased risk of motor vehicle accident (MVA) within 3-days, 7days, and up to 1-month after ingestion of CNS-D drugs (Dassanayake, Jones, et al., 2012). Based on this evidence the authors were concerned that patients medically fit for discharge were still suffering cognitive and psychomotor impairments no longer attributable to pharmacological properties. At present the experimental literature reviewed in this thesis suggests that single and multiple therapeutic doses of central nervous system depressant (CNS) drugs (benzodiazepines, z-drug, antidepressants, opioids, and antipsychotics) have the capacity to impair simulated or actual driving ability in both healthy volunteers and patients diagnosed with various psychiatric disorders (e.g., anxiety; van Laar, Volkerts, & van Willigenburg, 1992). Evidence of a dose-response relationship suggests that supratherapeutic doses of CNS-D drugs can result in greater impairment. Examination of the epidemiological literature, again reviewed in this thesis, into the influence of CNS-D drugs on risk of motor vehicle accident (MVA) found that receiving or dispensing a prescription of CNS-D drugs up to 1-month prior increased the risk of MVA. Again a dose-response relationship suggests increasing the dose of CNS-D drugs increases the risk of MVA (Chang et al., 2012). Despite evidence suggesting that patients discharged from hospital after DSP with CNS-D drugs have impaired cognitive and psychomotor function, no longitudinal cohort study has been conducted to support this claim. However, other factors could account for extended risk of MVA (4-weeks). These factors include, personality (Schwebel, Severson, Ball, & Rizzo, 2006), insight (Anstey, Wood, Lord, & Walker, 2005), vocational, financial, and/or interpersonal concerns (Selzer, 1969). Methodology: This thesis reports a longitudinal cohort study that included patients admitted to hospital for DSP with CNS-ND or CNS-D drugs. Both groups provided self-assessment information of their cognitive and driving capabilities and performed neuropsychological tests that examined cognitive flexibility, cognitive efficiency, working memory, visual…