Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder

Abstract

Antipsychotic polypharmacy and high doses have been associated with poorer outcome, longer hospital stays, and increased side effects. The present naturalistic study assessed the cognitive effects of antipsychotics in 56 patients with a diagnosis of schizophrenia or schizoaffective disorder, using the Brief Assessment of Cognition in Schizophrenia (BACS). Antipsychotic daily dose (ADD) was expressed as mg risperidone equivalents/day (RIS eq), using a model based on drug doses from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study for second generation antipsychotics (SGA) and chlorpromazine equivalents for first generation antipsychotics (FGA), with a 1/1 equivalence between haloperidol and risperidone. Increasing age was associated with polypharmacy, FGA prescription and decreasing BACS score. FGA prescription, in turn, predicted a poorer cognitive functioning, independently of age, PANSS subscores and ADD. ADD was associated with decreasing cognitive scores, an effect that remained significant after controlling for age, PANSS or polypharmacy. The detrimental cognitive effects of polypharmacy, in turn, appeared to be mediated by ADD. Different methods of data fitting suggested that ADD above 5-6 mg RIS eq/day were associated with lower BACS scores. Overall, these results show that increasing antipsychotic daily dose is associated with poorer cognitive functioning at doses lower than previously thought, independently of the number of antipsychotic drugs.

Clarifying Delirium Management: Practical, Evidenced-Based, Expert Recommendations for Clinical Practice

“…[100][101][102][103][104][105][106][107] Other studies have not replicated these findings. 108 These data do not address the risk of short-term use of antipsychotics to manage delirium and cannot be extrapolated to this situation.…”

Antipsychotic polypharmacy – confusion reigns

“…16 Other evidence suggests antipsychotic polypharmacy increases time in hospital 17 and decreases cognitive performance. 18 There is more contentious evidence that polypharmacy increases the risk of metabolic disturbances. [19][20][21][22] Worryingly, this apparently dangerous and poorly supported practice may be more common in Black and minority ethnic patients than in White patients.…”

Prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in an upper-middle-income country

“…[3][4][5]9,10 In addition, there is evidence for harm associated with APP. Research has shown an association of APP with increased adverse effects, including extrapyramidal effects, [11][12][13] hyperprolactinemia, [14][15][16] sexual dysfunction, 17 hypersalivation, 18 sedation, 14 cognitive impairment, 19 and diabetes. 20,21 Possible increased risk of sudden cardiac death 22 and mortality 23,24 has been suggested.…”