4 Psychiatric Disorders - DVLA Assessing Fitness to Drive Guide

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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.

Advice for medical professionals for drivers with .

X - Must not drive! - May continue to drive subject to medical advice and/or notifying the DVLA√ - May continue to drive and need not notify the DVLA

Anxiety or depression – mild to moderate

 Group 1
car and motorcycle
Group 2
bus and lorry
Without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts√- May drive and need not notify the DVLA.

See Appendix E for medication considerations relevant to driving.

! - May drive and need not notify the DVLA, provided the illness is short-lived.

For other cases, refer to 'severe' below.

See Appendix E for medication considerations relevant to driving.

Persistent alcohol and/or drug misuse or dependence

  • See Chapter 5.
  • If psychiatric illness has been associated with substance misuse, continued misuse contraindicates driving or licensing.

Severe anxiety or depression

Note: effects of severe illness are of greater importance for their relevance to driving than medication – see Appendix E, for the additional considerations on medication.

 Group 1
car and motorcycle
Group 2
bus and lorry
Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughtsX- Must not drive and must notify the DVLA.

Licensing will depend on the outcome of medical enquiries, and the DVLA will require a period of stability.

Particular danger would be posed by those who may attempt suicide at the wheel.

X- Must not drive and must notify the DVLA.

Licensing will depend on the outcome of medical enquiries, and the DVLA will require a period of stability.

Particular danger would be posed by those who may attempt suicide at the wheel.

Must not drive and must notify the DVLA.

Licensing may be granted after 6 months if:

♦ the person has been well and stable and
♦ is not taking medication with side effects that would affect alertness or concentration.

The DVLA may need reports from a specialist in psychiatry.

Driving is usually permitted after 6 months if the anxiety or depression has been long-standing but symptoms are under control and if maintenance on a dosage of psychotropic medication does not cause impairment.

Acute psychotic disorder

Persistent alcohol and/or drug misuse or dependence

  • See Chapter 5.
  • If psychiatric illness has been associated with substance misuse, continued misuse, contraindicates driving or licensing.
 Group 1
car and motorcycle
Group 2
bus and lorry
Without significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughtsX- Must not drive during acute illness and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 3 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject to a suitable specialist report being favourable.

Drivers with a history of instability and/or poor engagement with treatment will be required not to drive for a longer period before any relicensing.

X- Must not drive during acute illness and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 12 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject of a favourable report from a specialist in psychiatry.

The minimum effective antipsychotic dosage should be sought, in line with good practice. Drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance.

Established illness with a history suggesting a likelihood of relapse: the risk of this needs to be considered low.

The DVLA will normally require the report of a specialist in psychiatry that specifically addresses the above issues as relevant to driving before it may grant a licence.

Hypomania or mania

Persistent alcohol and/or drug misuse or dependence

  • See Chapter 5.
  • If psychiatric illness has been associated with substance misuse, continued misuse, contraindicates driving or licensing.

For Group 2 bus and lorry driving, in both stable and unstable conditions:

  • the minimum effective dosage of any antipsychotic medication should be sought, in line with good practice. Drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance
  • established illness with a history to suggest a likelihood of relapse: the risk of this must be considered low.
 Group 1
car and motorcycle
Group 2
bus and lorry
Stable
There must be no driving during any acute illness.
X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 3 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject to a suitable specialist report being favourable.

X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 12 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject to a suitable specialist report being favourable.

See note above for both stable and unstable conditions.

Unstable
4 or more episodes of significant mood swing in the previous 12 months. Particular danger would be posed by driving if there is hypomania or mania with repeated change of mood. In all cases, there must be no driving during any acute illness.
There must be no driving during any acute illness.
X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 6 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject of a favourable report from a specialist in psychiatry.

X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 12 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject to a suitable specialist report being favourable.

See note above for both stable and unstable conditions.

Schizophrenia – and other chronic relapsing/remitting disorders

Persistent alcohol and/or drug misuse or dependence

  • See Chapter 5.
  • If psychiatric illness has been associated with substance misuse, continued misuse, contraindicates driving or licensing.
 Group 1
car and motorcycle
Group 2
bus and lorry
There must be no driving during any acute illness

Driving would be particularly dangerous if psychotic symptoms relate to other road users

X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for at least 3 months
♦ adheres adequately to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject to a suitable specialist report being favourable.

Continuing symptoms: even with limited insight, continuing symptoms do not necessarily preclude licensing.

Symptoms should be unlikely to cause significant concentration problems, memory impairment or distraction while driving.

X- Must not drive and must notify the DVLA.

Licensing may be considered if all of these conditions are met:

♦ remained well and stable for
♦ at least 12 months
♦ adheres to any agreed treatment plan
♦ regained insight
♦ free from any medication effects that would impair driving
♦ subject of a favourable report from a specialist in psychiatry.

Further:

♦ the minimum effective dosage of any antipsychotic medication should be sought, in line with good practice. Drug tolerability should be optimal and not associated with any deficits that might impair driving, such as to alertness, concentration or motor performance
♦ established illness with a history to suggest a likelihood of relapse: the risk of this must be considered low.

Pervasive developmental disorders and ADHD

 Group 1
car and motorcycle
Group 2
bus and lorry
Any pervasive disorder including attention deficit hyperactivity disorder (ADHD), Asperger's syndrome, autism spectrum disorders (ASD) and severe communication disorders
Guidance relating to learning disability is below
!- May be able to drive but must notify the DVLA.

A diagnosis of any of these conditions is not in itself a bar to licensing.

The DVLA considers factors such the level of:

♦ impulsivity
♦ awareness of impacts of behaviours on self or others.

!- May be able to drive but must notify the DVLA.

Licensing will be considered individually following medical enquiries.

Licensing may be granted if continuing symptoms are minor.

Mild cognitive impairment (not mild dementia)

 Group 1
car and motorcycle
Group 2
bus and lorry
No likely driving impairment√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
Possible driving impairmentX- Must not drive and must notify the DVLA.

Licensing will be considered individually following medical enquiries.

X- Must not drive and must notify the DVLA.

Licensing will be considered individually following medical enquiries.

Persistent alcohol and/or drug misuse or dependence

  • See Chapter 5.
  • If psychiatric illness has been associated with substance misuse, continued misuse contraindicates driving or licensing.

Dementia – and/or any organic syndrome affecting cognitive functioning

Group 1
car and motorcycle
Group 2
bus and lorry
! - May be able to drive but must notify the DVLA.

It is difficult to assess driving ability in people with dementia. The DVLA acknowledges that there are varied presentations and rates of progression, and the decision on licensing is usually based on medical reports.

Considerations include:

♦ poor short-term memory, disorientation, and lack of insight and judgement almost certainly mean no fitness to drive
♦ disorders of attention cause
impairment
♦ in early dementia, when sufficient skills are retained and progression is slow, a licence may be issued subject to annual review.

A formal driving assessment may be necessary (see Appendix G).

X- Must not drive and must notify the DVLA.

Licensing will be refused or revoked.

Learning disability

Definition of severe learning disability followed by the DVLA

Significantly below average general intellectual functioning, accompanied by severe limitations in adaptive functioning in at least two of these areas:

  • communication
  • functional academic skills
  • self-care
  • work
  • home-living
  • leisure
  • social/interpersonal skills
  • health and safety
  • self-direction
 Group 1
car and motorcycle
Group 2
bus and lorry
Mild learning disability
Learning difficulty is not included. Dyslexia, dyscalculia, and so on, are no bar to ordinary Group 1 licences being awarded after successful driving tests, and the DVLA need not be informed
! - May be able to drive but must notify the DVLA.

Licensing will be granted provided there are no other relevant problems.

The DVLA may require an assessment of adequate functional ability at the wheel.

X- Must not drive and must notify the DVLA.

Licensing may be granted provided there are only minor degrees of learning disability and the condition is stable with no medical or psychiatric complications.

SevereX- Must not drive and must notify the DVLA.

Licensing with be refused.

X- Must not drive and must notify the DVLA.

Licensing with be refused.

Behavioural disorders – including post-head injury, non-epileptic seizures

 Group 1
car and motorcycle
Group 2
bus and lorry
Severe disturbance with syndrome post-head injury, non-epileptic seizure disorder (NESD), for exampleX- Must not drive and must notify the DVLA.

Licensing will be refused or revoked if there is serious disturbance – for example, violent behaviour or alcohol abuse likely to be a source of danger at the wheel.

Licensing may be granted after medical reports confirm satisfactory control of behavioural disturbances.

X- Must not drive and must notify the DVLA.

Licensing will be refused or revoked if there is serious disturbance – for example, violent behaviour or alcohol abuse likely to be a source of danger at the wheel.

Licensing may be granted if a specialist confirms stability.

Personality disorders

 Group 1
car and motorcycle
Group 2
bus and lorry
Severe disturbanceX- May be able to drive but must notify the DVLA.

Licensing will be refused or revoked if there is likely to be danger at the wheel.

Licensing may be granted if behavioural disturbance is:

♦ not related to driving
or
♦ not likely to adversely affect driving and road safety.

X- Must not drive and must notify the DVLA.

Licensing will be refused or revoked if there is likely to be danger at the wheel.

♦ Licensing may be given consideration if a specialist confirms stability.

© Crown copyright. Reproduced under the terms of the Open Government Licence.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
DVLA
Current Version:
Peer Reviewer:
DVLA
Document ID:
13219 (v5)
Last Checked:
17/06/2016
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