The effect of anticholinergic burden - A 21-year prospective cohort study

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# The effect of anticholinergic burden of psychiatric medications on major outcome domains of psychotic disorders: A 21-year prospective cohort study

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.

Keywords: Anticholinergic burden; Cognition; Negative symptoms; Outcome; Psychosis; Psychosocial functioning.

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Check out this calculator

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i struggle with all those. took antipsychotics since age 11. total years about 17 years long.

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I scored an 8. 151515

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According to internet searches my AP, Vraylar, has no anticholinergic activity. But I was on invega and Aripiprazole for years. BOth of which have a score of 1.

I was also on sertraline for years, with a score of 1.

Edit: I have a current score of 2 though, with metformin and bupropion(wellbutrin) with a score of 1 each.

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I scored 2 on the calculator.

Abilify and Metformin. 1 each.

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Ziprasidone and Luvox are each 1 and Cogentin and Hydroxyzine are each 3. Not sure what to do about it.

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Interesting. Respiridone isnt on there, im considering switching to it

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Watch the spelling. Try Risperidone

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Damn, it is on there

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I’ve just read up on the values of beta in statistics, and I don’t understand why the value of beta is negative in the last parentheses. As I understand, the permissible range is from 0 to 1.

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Or maybe I was thinking about the wrong beta? And it’s some other beta, which could assume negative values? I asked in the chatroom of Statistics SE, and they said it might be a “regression coefficient”, whatever that may be.

I just wanted to know what these values mean, and how strong is the association between the anticholingeric burden and these unwanted side effects.