Anticholinergic burden in schizophrenia and ability to benefit from psychosocial treatment programmes: a 3-year prospective cohort study

O’Reilly, Ken; O’Connell, Paul; Donohoe, Gary; Coyle, Ciaran; O’Sullivan, Danny; Azvee, Z.; Maddock, Catherine; Sharma, Kapil; Sadi, Herika de Mesquita; McMahon, Michael; Kennedy, Harry G

doi:10.1017/s0033291716002154

Cited by 33 publications

(21 citation statements)

References 64 publications

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“…O’Reilly et al recently reported that anticholinergic burden negatively impacted the outcomes of psychosocial treatment focusing on cognitive impairment in patients with schizophrenia (O’Reilly et al, 2016). Because cognitive impairment related to anticholinergic burden may affect skills necessary for independent living and vocational success, it is important for clinicians to appreciate the cumulative effects of anticholinergic drug regimen properties on cognition.…”

Section: Discussionmentioning

confidence: 99%

Cognitive burden of anticholinergic medications in psychotic disorders

Eum

Hill

Rubin

et al. 2017

Schizophrenia Research

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Background Patients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Method Clinically stable participants with schizophrenia (n=206), schizoaffective disorder (n=131), and psychotic bipolar disorder (n=146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS). Results Anticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥4 had lower composite BACS scores compared to those with ADS<4 (p=0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder. Conclusion We identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one’s medication regimen may be important to consider in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Cognitive burden of anticholinergic medications in psychotic disorders

Eum

Hill

Rubin

et al. 2017

Schizophrenia Research

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“…Randomized controlled trials in this field are difficult and there are few available as guides [ 12 , 13 ]. Paradoxically pharmacotherapy may compromise the effectiveness of psychosocial interventions to some extent by impairing neurocognition and functioning [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

et al. 2018

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BackgroundWe evaluated change in response to multi-modal psychosocial ‘treatment as usual’ programs offered within a forensic hospital.MethodsSixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients’ cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores.ResultsThe DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3.ConclusionsChange in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients’ ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions.

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“…1 There is already evidence that symptoms are related to neurocognitive changes 2 and that neurocognitive impairments influence the behavioural handicaps of schizophrenia 3 and treatment responses. 4 Functional mental capacity is often used to refer to functional decision-making abilities required by a patient to make legally competent decisions about their care. 5 Cross-sectional studies show that between 43.8% 6 and 60% 7 of patients admitted to a psychiatric hospital lack treatment-related functional decisional capacity at a given time.…”

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confidence: 99%

The recovery of factors associated with decision-making capacity in individuals with psychosis

Fernández

Kennedy

2017

BJPsych open

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BackgroundThere is limited data on the recovery of factors associated with decisional capacity in patients with psychosis.AimsTo study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis.MethodFifty-six patients with psychosis were assessed for capacity to consent to treatment on admission and at 6 and 12 weeks following treatment. The MacArthur Competence Assessment Tool – Treatment, the Positive and Negative Symptom Scale and the Global Assessment of Functioning Scale were used to measure mental capacities, symptom severity and global functioning respectively. Treating consultants rated capacity to consent, masked to these measures.ResultsGreater impairments on all measures were found in patients assessed as lacking capacity. These improved with treatment over 12 weeks with significant effect sizes (0.5 to 0.6). Stronger correlations between mental capacities, positive symptoms (−0.47) and global functioning (0.56) were noted in the first 6 weeks.ConclusionsImpairments in capacity in acute stages of psychosis are related to symptom severity and functional impairment. They improve during treatment, particularly in the first 6 weeks.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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Anticholinergic burden in schizophrenia and ability to benefit from psychosocial treatment programmes: a 3-year prospective cohort study

Cited by 33 publications

References 64 publications

Cognitive burden of anticholinergic medications in psychotic disorders

Cognitive burden of anticholinergic medications in psychotic disorders

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

The recovery of factors associated with decision-making capacity in individuals with psychosis

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