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Schizophrenia: Antipsychotic choice may influence driving-related cognitive performance

Key clinical point: Schizophrenia patients treated with aripiprazole and paliperidone exhibited superior driving-related cognitive performance than those treated with haloperidol and risperidone.

Major finding: 63% of patients passed the Cognitive Perceptual Assessment for Driving (CPAD) test and were ruled as competent to drive. The passing rates of patients taking haloperidol, risperidone, olanzapine, aripiprazole, and paliperidone were 33%, 57%, 57%, 75%, and 82%, respectively, with a significant difference between the haloperidol and aripiprazole groups (P = .005) and between the haloperidol and paliperidone groups (P = .001).

Study details: This cross-sectional study compared the effect of 5 antipsychotics on driving-related cognitive performance using the CPAD test in 102 adults with schizophrenia.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.


“Driving is a complex behavior that requires adequate vision, appropriate motor function and cognitive functioning that allow for attention to emerging events, assessment of those events and wise decision-making. Impairments in any of these areas can make it difficult for individuals to be safe drivers. People with schizophrenia may have problems with cognitive functioning intrinsic to their illness, and/or related to treatment factors such as side effects of antipsychotic medication. This retrospective analysis of outpatients with schizophrenia found higher proportions of individuals deemed competent to drive as compared to some previous research studies that included inpatients and those with more severe psychotic symptoms.

There were some differences in various cognitive domains even after consideration of demographic and illness related factors across several antipsychotic treatment groups. Findings also underscore the fact that assessment of complex behaviors such as driving need to consider a range of factors including patient age, symptom severity, drug treatment, drug side effects and other clinical circumstances to help clinicians and other specialists estimate safe driving skills in their patients.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

Willard Brown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine


Noh S et al. J Psychiatr Res. 2020 Aug 29. doi:10.1016/j.jpsychires.2020.08.029.