{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T14:28:35Z","timestamp":1784989715751,"version":"3.55.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012682","name":"University of Oulu Scholarship Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012682","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Finnish Psychiatric Association"},{"DOI":"10.13039\/100010125","name":"Jalmari and Rauha Ahokas Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010125","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Iso-M\u00e4llinen Foundation"},{"DOI":"10.13039\/501100006196","name":"University of Oulu","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Terttu Foundation"},{"name":"Oulu University Hospital"},{"name":"wellbeing services county of Northern Ostrobothnia"},{"DOI":"10.13039\/501100008488","name":"Alma and K.A. Snellman Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008488","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Oulu, Finland"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antipsychotics, antidepressants, and benzodiazepines are commonly used among patients with psychotic disorders. The use of psychotropic medication, alcohol, and illicit drugs may have a major role in the fatal motor vehicle accidents (FMVA) involving drivers with psychotic disorders. This study on drivers involved in FMVAs in Finland investigates the post-mortem toxicology findings regarding the presence of psychotropic medication, alcohol and illicit drugs among 94 drivers with psychotic disorders and their 188 matched controls without psychiatric disorders. Drivers\u2019 suicidal intention, death category, and role in the accident were also investigated. Psychotropic medication was present in 53.2% of drivers with psychotic disorders and in 9.6% of controls at the time of their FMVA. Among the drivers with psychotic disorders, the presence of antipsychotics was detected in 30% of them, and their suicidal intentions behind FMVA were significantly associated with the presence of antipsychotics (OR 2.7) and mood stabilizers (OR 6.0). Our results suggest that, in some cases, traffic suicides among drivers with psychotic disorders may originate from long-term suicidal thoughts and occur despite antipsychotic medication. A thorough fitness-to-drive assessment should be conducted for patients with psychotic disorders, irrespective of their antipsychotic medication status.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf263","type":"journal-article","created":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T12:48:25Z","timestamp":1766234905000},"source":"Crossref","is-referenced-by-count":1,"title":["The role of psychotropic medication, alcohol, illicit drugs, and suicidal intention in fatal motor vehicle accidents involving drivers with psychotic disorders"],"prefix":"10.1093","volume":"36","author":[{"given":"Jussi","family":"Koskinen","sequence":"first","affiliation":[{"name":"Research Unit of Clinical Medicine, Psychiatry, University of Oulu , Oulu,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helin\u00e4","family":"Hakko","sequence":"additional","affiliation":[{"name":"Research Unit of Population Health, University of Oulu , Oulu,","place":["Finland"]},{"name":"Department of Psychiatry, Oulu University Hospital , Oulu,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirkko","family":"Riipinen","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Psychiatry, University of Oulu , Oulu,","place":["Finland"]},{"name":"Department of Psychiatry, Oulu University Hospital , Oulu,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niina","family":"Sihvola","sequence":"additional","affiliation":[{"name":"Finnish Crash Data Institute (OTI) , Helsinki,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu-Helmi","family":"Halt","sequence":"additional","affiliation":[{"name":"Research Unit of Clinical Medicine, Psychiatry, University of Oulu , Oulu,","place":["Finland"]},{"name":"Department of Psychiatry, Oulu University Hospital , Oulu,","place":["Finland"]},{"name":"Medical Research Center, Oulu University Hospital and University of Oulu , Oulu,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"2026040119315518400_ckaf263-B1","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.schres.2018.09.005","article-title":"Simulated car driving and its association with cognitive abilities in patients with schizophrenia","volume":"204","author":"Fuermaier","year":"2019","journal-title":"Schizophr Res"},{"key":"2026040119315518400_ckaf263-B2","doi-asserted-by":"publisher","first-page":"152340","DOI":"10.1016\/j.comppsych.2022.152340","article-title":"Driving fitness in clinically stable outpatients with chronic schizophrenia","volume":"118","author":"Biedermann","year":"2022","journal-title":"Compr Psychiatry"},{"key":"2026040119315518400_ckaf263-B3","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.psychres.2015.11.013","article-title":"Use of psychiatric medications in schizophrenia and other psychoses in a general population sample","volume":"235","author":"Nyk\u00e4nen","year":"2016","journal-title":"Psychiatry Res"},{"key":"2026040119315518400_ckaf263-B4","doi-asserted-by":"publisher","first-page":"2537","DOI":"10.1007\/s00213-022-06146-0","article-title":"Use of psychotropic medication and risk of road traffic crashes: a registry-based case-control study in Denmark, 1996-2018","volume":"239","author":"Olesen","year":"2022","journal-title":"Psychopharmacology (Berl)"},{"key":"2026040119315518400_ckaf263-B5","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s00406-009-0014-4","article-title":"Driving simulator performance and psychomotor functions of schizophrenic patients treated with antipsychotics","volume":"259","author":"Brunnauer","year":"2009","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"2026040119315518400_ckaf263-B6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.schres.2019.11.053","article-title":"A short survival time after last psychiatric hospitalization in drivers with psychotic disorder killed in fatal motor vehicle accidents","volume":"216","author":"Keski-Filppula","year":"2020","journal-title":"Schizophr Res"},{"key":"2026040119315518400_ckaf263-B7","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1007\/s00127-021-02153-2","article-title":"A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors","volume":"56","author":"Sicotte","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2026040119315518400_ckaf263-B8","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.schres.2010.09.009","article-title":"Epidemiology of suicide attempts among persons with psychotic disorder in the general population","volume":"124","author":"Suokas","year":"2010","journal-title":"Schizophr Res"},{"key":"2026040119315518400_ckaf263-B9","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.jpsychires.2016.10.010","article-title":"Drivers\u2019 psychiatric disorders and fatal motor vehicle accidents in Finland","volume":"84","author":"Kujansuu","year":"2017","journal-title":"J Psychiatr Res"},{"key":"2026040119315518400_ckaf263-B10","author":"The Finnish Crash Data Institute (OTI)","year":"2025"},{"key":"2026040119315518400_ckaf263-B11","author":"Finnish Institute for Health and Welfare","year":"2025"},{"key":"2026040119315518400_ckaf263-B12","author":"Statistics Finland"},{"key":"2026040119315518400_ckaf263-B13","author":"Forsman","year":"2019"},{"key":"2026040119315518400_ckaf263-B14","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1002\/dta.1507","article-title":"Drug concentrations in post-mortem femoral blood compared with therapeutic concentrations in plasma","volume":"6","author":"Launiainen","year":"2014","journal-title":"Drug Test Anal"},{"key":"2026040119315518400_ckaf263-B15","author":"WHO Collaborating Centre for Drug Statistics Methodology","year":"2025"},{"key":"2026040119315518400_ckaf263-B16","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.trf.2024.07.028","article-title":"A systematic review of road traffic suicides: do we know enough to propose effective preventive measures?","volume":"106","author":"Radun","year":"2024","journal-title":"Transp Res Part F Traffic Psychol Behav"},{"key":"2026040119315518400_ckaf263-B17","doi-asserted-by":"publisher","first-page":"119660","DOI":"10.1016\/j.jad.2025.119660","article-title":"Before the attempt: how people think and plan in suicide crises","volume":"389","author":"Xu","year":"2025","journal-title":"J Affect Disord"},{"key":"2026040119315518400_ckaf263-B18","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1017\/S003329171900391X","article-title":"Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation","volume":"50","author":"Liu","year":"2020","journal-title":"Psychol Med"},{"key":"2026040119315518400_ckaf263-B19","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1176\/appi.ajp.161.4.692","article-title":"Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia","volume":"161","author":"Gilmer","year":"2004","journal-title":"Am J Psychiatry"},{"key":"2026040119315518400_ckaf263-B20","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1017\/s0033291703008328","article-title":"How often do patients with psychosis fail to adhere to treatment programmes? A systematic review","volume":"33","author":"Nos\u00e9","year":"2003","journal-title":"Psychol Med"},{"key":"2026040119315518400_ckaf263-B21","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1016\/j.schres.2024.06.037","article-title":"A letter to the editor: the impact of comorbid depression and substance use disorder on drivers with a psychotic disorder killed in motor vehicle accidents","volume":"270","author":"Koskinen","year":"2024","journal-title":"Schizophr Res"},{"key":"2026040119315518400_ckaf263-B22","author":"Finnish Crash Data Institute","year":"2021"},{"key":"2026040119315518400_ckaf263-B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.forsciint.2012.04.012","article-title":"Car accidents as a method of suicide: a comprehensive overview","volume":"223","author":"Pompili","year":"2012","journal-title":"Forensic Sci Int"},{"key":"2026040119315518400_ckaf263-B24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.injury.2011.06.192","article-title":"Motor vehicle accident or driver suicide? Identifying cases of failed driver suicide in the trauma setting","volume":"43","author":"Henderson","year":"2012","journal-title":"Injury"},{"key":"2026040119315518400_ckaf263-B25","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1002\/pds.4426","article-title":"Comparison of dispensed medications and forensic-toxicological findings to assess pharmacotherapy in the swedish population 2006 to 2013","volume":"27","author":"Forsman","year":"2018","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026040119315518400_ckaf263-B26","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1159\/000506868","article-title":"Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications","volume":"89","author":"Cosci","year":"2020","journal-title":"Psychother Psychosom"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/advance-article-pdf\/doi\/10.1093\/eurpub\/ckaf263\/66938349\/ckaf263.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/2\/ckaf263\/66938349\/ckaf263.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/2\/ckaf263\/66938349\/ckaf263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T23:32:03Z","timestamp":1775086323000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckaf263\/8487808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,14]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckaf263","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,2,16]]},"article-number":"ckaf263"}}