So, if you have other questions, write them down. If you think of something, burning questions on diabetes or anything else, write them down. I'll move on to psychology. Always fun because, you know, drivers are the perfect picture of mental health, as are, of course, medical health or medical professionals. All right. Everyone has one question, and it's pretty vague. And when they answer yes, if they answer yes, they all have anxiety, because that apparently is the most socially acceptable right now mental health disorder to have. And so I had a gentleman this week that checked yes to this, and you look at him, and you're like, hmm, he doesn't look anxious to me. He looks more like he has a different problem. And sure enough, he did. All right. So here's the regulation. Can't have any mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with operating a state. It's a huge, broad regulation, right? So now we do to the MAC. And again, it's a good reminder, these, you know, mental health, this is not a benign thing. It can cause a lot of problems. They mention a few here. All right. Dizziness, confusion, weakness, paralysis, inattention, incoordination, poor ability to multitask, reaction time be slowed. They also go on to say you should do a history. Okay. Well, thank you for that reminder. I appreciate that. They do also go on to comment that it is unlikely that people that are unstable would meet the standard. Okay. So they don't define stability. But like everything we've talked about all day, is treatment adequate, safe, and are they stable? What percent people answered yes for that? Check that box. I don't have any idea. A lot? I don't have a number. I'm sorry. So that would be a better question for the FMCSA about, because they can aggregate that kind of stuff. I have no idea. But I do know that mental health disorders are quite common in this country. So anyway, they don't really define this. But because, again, because this is in the medical advisory criteria, it carries a little bit more weight than it does from the handbook, for example. So if you've got somebody that's, you're not sure if they're stable, keep this in mind. They also, which is a very good point to point out, medications used to treat these disorders are not necessarily very benign. So it's not just the disorder. What are you treating it with? Okay. And so, for example, my gentleman that came and saw me earlier in the week, who said he had anxiety, was being treated with an antipsychotic medication. So the plot thickens. All right. And again, now the handbook goes on to reiterate what the MAC has already pointed out. Basically a reminder of things that you should have learned in school about mental health and how it can affect your ability to function in the world. You should do a medical assessment, which includes a general idea of how they interact with you and you interact with them. Okay. I mean, I get a lot of information, just walk in my patient, walk down the hallway. Okay. And you should not only consider the disorder itself, but the treatment and any residual symptoms. And again, driving a truck is really, really very difficult. Okay. Particularly for those that are the over-the-road guys. Okay. The UPS or FedEx guys that deliver this, or the Amazon drivers that deliver stuff to your house, they're not too bad. Still pretty physical job, but they're home every night. They have a predictable schedule. For the over-the-road guys, you're away from home. You probably have a tether through your phone. You don't get a lot of exercise. There's a lot of hurry up and wait. You pull into the terminal. You're thinking, oh, I got to get this load going and, oh, well, the trailer's not quite loaded. You're going to have to kill a couple hours while I do this. So now your duty day has been pushed longer. The food choices that are available to you are crappy. It's a very... You're alone. You may be alone, or you may be with a total stranger that you've never met before who's a little funny himself. So it's not an easy life, and it can really bring out some of these... So if you're a little on edge because you're a little anxious or a little depressed, sitting in the cab of a commercial large tractor is not going to help your mental health. Okay? It just isn't, in my opinion. That's an opinion. Take it or leave it. All right. So again, the handbook goes on to say, what's the reason they're taking that medication? Again, my example of the gentleman who has anxiety being treated with an antipsychotic. That should be a red flag saying, wait a minute. And as I explained to him, I'm not saying that he's not. I'm just saying this is pretty unusual. So we're going to ask some more questions. What's the dosage? What are the side effects? And how do they affect? I don't know. I usually have to ask those questions of the treating doctor. Has the treatment worked? Again, these are the same questions we've seen all the way along. Case by case, don't pigeonhole. The certification decision should not be based on the diagnosis alone. So this is my speech about medications. I love MCSA 5995, or actually 5895, typo. 5895? 5895? For revision? I love that form, because it asks a lot of good questions, including what medicines you take, why do you take them, and what other medicines do they take? So it gets at a lot of good information. I use that form a lot. And my favorite is when the guy comes in, he goes, yeah, I take a blood pressure pill, I take a cholesterol pill, and I take a reflux pill. I don't know the names. No problem. I got a form for you to take to your doctor. It's amazing what you find out. Love this form. I use it quite frequently. Medications are, you know, there's a pill for everything right now, right? And not a lot of them are benign. So first generation versus second generation, they all can have side effects. They're not necessarily predictable from person to person. If you ask the driver, nope, they work, and I don't have any side effects. Maybe they do, maybe they don't. Antipsychotics, again, and they may not be used for psychosis, but they're still used. Anxiolytic and sedative hypnotics, there is data out there that shows that there's increased crash risk for a lot of these drugs. Trazodone's making a comeback. The half-life of that drug is 15 hours. What's the number one medication found in pilots who crash their planes and die? Number one medication, diphenhydramine. Legal doesn't mean safe. Benzodiazepines, they say may impair less in non-benzodiazepines. They don't say doesn't impair. There is definite increased crash with benzos. Barbiturates, they also mention stimulants. That's the same as everything else, but again, remember the underlying disorder as well. So if you do this for pilots, you know the FAA is really not very happy about pilots that are taking a medication to keep their attention focused. It's the underlying disorder, too. Can I just ask you a question? How do you actually handle this? Because when I was doing fitness for duty examinations and looking at mental health issues, it's really complicated. Often you have a psychiatrist, a biopsychologist, and you just spend the time and energy to do this. I don't know how you do it. That's your job. That's your job. I mean, I'm sorry. That's your job. I mean, if you don't want to do that, then don't do these exams. I mean, that's the bottom line. You have to take the time to do it. And again, you have to consider them on a case-by-case basis as individuals. You have to look at all the facts, and if you have to get the opinion of a specialist, I'm not a psychologist or a psychiatrist. I'm not a cardiologist either. If I need an opinion, I'm going to go get it. If I need medical records, I'm going to ask for it. At the end of the day, that's all you can do. Is it time-consuming? Sometimes. For every physical I can whip out in five minutes, there's another one that's going to take me an hour. And that's what the expectation is, in my opinion, is you do what you need to do to make a decision. And yeah, sometimes you charge whatever you charge for the exam, and you've worked harder than that. But it's what it is. It is what it is. So these are just some considerations. Okay, so they're pointing out in the handbook about, you know, these have the potential to impair, so you should think about that. They also talk about ECT. Again, they're just pointing out things to think about. Same with lithium, right? Do you want to get some lithium levels? That implies stability. One of the other things that I kind of think about with medication in particular, oh, I just take my Xanax as needed, all right, PRN as needed. Is that stable if I take things PRN? Again, something to think about. I'm not going to tell you my answer. When they say standard considerations, is that the same thing? Is treatment effective, safe, effective, et cetera? Bipolar, major depression, again, these are just some things to think about. You should be thinking about this stuff anyway. But this is a reminder. Pull the handbook out. If it's been a while since you've dealt with people with mental health issues, use this to trigger some more thoughts in your head, all right? PTSD, I see it a lot in the veteran population that I deal with. There's PTSD and there's PTSD, right? There's some PTSD. It's a spectrum. Some people's PTSD is crippling. Others, it's very trigger-related, right? They hear a loud bang and they're under the table, right? So what happens when their truck backfires, right, or whatever? What's the trigger, PTSD? Is it only loud noises? Is it only dark spaces? Is it only, you know, or is it more generalized? You've got to ask. The other thing is, you know, are they under care? Are they seeing somebody at the VA because they have ongoing issues with their PTSD? Is it something they got 10% disability from the VA for and they really don't have a lot of issues with it? But ask the questions. Personality disorders, I, you know, again, they do comment about the overt inappropriate acts which go with personality disorders. I don't know that I've ever seen a driver with an overt personality disorder because those people tend to be, have a lot of other issues functioning in society. But again, it's a case-by-case basis. You can't lump them. Schizophrenia. Again, the certification is not based on the diagnosis alone. But they do comment in the handbook that, again, like the MAC, if they're unstable, which, you know, again, instability is a theme we've preached all day, whether, regardless of what it's caused by, but they do say if they're unstable. So I'll tell you a little quick story that I've, Natalie's probably heard me say too much. But one of my mentors back when I first started doing this was a guy named Dr. Ellison Whittles. And I was really new with this. And I had a guy come in who was pretty normal looking guy, very quiet though, didn't talk much, who had actually been coming to the clinic that I had just started working in for years. And he had paranoid schizophrenia. And he was on an anti-psychotic medication. So if you look at the material that was there at the time, disqualification was the way to go. Well, this guy had been getting certified for years from other people. And I was like, well, God, am I going to be the jerk that's going to take this guy out of his job? So I called up Dr. Whittles, who was our subject matter expert at the time, and, you know, he listened to me talk. He said at the end of that, he goes, so he's been on this stuff. He's never had any changes. He's been taking his medication. He's going to his doctor. He goes, well, hell, if it was up to me, I'd hire nobody but paranoid schizophrenics. They just want to go to work. They just want to be left alone. They're perfect. He said, I don't see why you can't qualify him. So anyway, that's just a story. Break up the monotony, right? So anyway, again, it goes back to this. Schizophrenia may or may not be disqualifying, but don't pigeonhole them. Just because somebody has that label doesn't mean that they're not qualified. And unfortunately, this gentleman that I saw earlier this week that I've been kind of talking to you about all along came in telling me he's got anxiety, but he's on an antipsychotic. When you look at the records, it looks like he does. He's got a family history of six, a strong family history of schizophrenia. He's probably schizophrenic. When I started talking to him about, hey, if you're schizophrenic and you're using these drugs, we've got some other hoops you're going to have to jump through. So start getting your ducks in a row kind of thing, because this is what I'm going to ask you for. Because then he started rethinking what he was telling me. And he looked like, I've seen people that have schizophrenia, and he kind of looked like that. Dementia, they may not have the ability to drive a CMB due to cognitive dissonance. They're not saying you can't. But they also remind you of the things that you should think about with somebody who carries a dementia diagnosis. They do have this resource available, the MEP in 2009, the MRB in 2010. I know mental health treatment has not changed at all in the last 15 plus years. But again, this is a starting point. And I still take advantage of this stuff for things that I don't see as often. But it's a start. So with that, I'm going to shut up and let you all ask some questions. And then we're in the home stretch. You all are doing good. We talk a lot about when you're preparing for this test, go back to the regulations. Go back to the what ifs and the scenarios we talk about, and we say it depends. Those are really not the kind of things that you... If you did nothing else but know the regs cold, particularly with hearing and vision and all of that, and how to complete, how to do the process, you're going to do fine on the test. There'll be a few questions in there, guess what I'm thinking. But for the most part, they're not going to give you some weird crap. I mean, if they do, they do. But if you get one wrong, you're not going to flunk.

mental health

anxiety

fitness-for-duty

commercial vehicle

psychiatric disorders