The effect of anticholinergic burden of psychiatric medications on major outcome domains of psychotic disorders: a 21-year prospective cohort study
Consultable a partir de
2025-02-01
Fecha
2024Autor
Versión
Acceso embargado / Sarbidea bahitua dago
Tipo
Artículo / Artikulua
Versión
Versión aceptada / Onetsi den bertsioa
Identificador del proyecto
Impacto
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10.1016/j.schres.2024.01.020
Resumen
Background: Most medications used to treat psychotic disorders possess anticholinergic properties. This may
result in a considerable anticholinergic burden (ACB), which may have deleterious effects on long-term outcomes. The extent to which cumulative ACB over years of treatment with psychotropic medications impacts
different outcome domains remains unknown.
Methods: This was a naturalistic st ...
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Background: Most medications used to treat psychotic disorders possess anticholinergic properties. This may
result in a considerable anticholinergic burden (ACB), which may have deleterious effects on long-term outcomes. The extent to which cumulative ACB over years of treatment with psychotropic medications impacts
different outcome domains remains unknown.
Methods: This was a naturalistic study of 243 subjects with first-episode psychosis aimed at examining the cumulative effect of ACB of psychotropic medications administered over the illness course (ACB-years exposure) on
several outcome domains assessed after a mean 21-year follow-up. Associations between ACB and the outcomes
were modelled accounting for relevant confounding factors by using hierarchical linear regression analysis.
Results: Over the study period, 81.9 % of the participants were dispensed at least one drug with strong anticholinergic effects for at least 1 year; at the follow-up visit, 60.5 % of the participants continued to take medications with strong ACB. ACB-years exposure was uniquely related to severity of negative symptoms (β = 0.144,
p = 0.004), poor psychosocial functioning (β = 0.186, p < 0.001) and poor cognitive performance (β = − 0.273, p
< 0.001). This association pattern was independent of a schizophrenia diagnosis. Most of the associations between ACB at the follow-up visit and the outcomes were accounted for ACB-years exposure.
Conclusion: Lifetime ACB of psychotropic medications has deleterious effects on the outcome of psychotic disorders. Clinicians should avoid prescribing medications with strong ACB, since there are numerous alternatives
within each psychotropic drug group for prescribing medications with low ACB. [--]
Materias
Psychosis,
Anticholinergic burden,
Outcome,
Cognition,
Negative symptoms,
Psychosocial functioning
Editor
Elsevier
Publicado en
Schizophrenia Research 264, (2024), 386–393
Departamento
Universidad Pública de Navarra. Departamento de Ciencias de la Salud /
Nafarroako Unibertsitate Publikoa. Osasun Zientziak Saila
Versión del editor
Entidades Financiadoras
The study was funded by the Spanish Ministry of Economy, Industry
and Competitiveness (grant PI16/02148 and 19/01698) and the
Regional Government of Navarra (grant 31/17 and 41/18).