Functioning and cognitive characteristics of clozapine users referred to psychosocial rehabilitation centers: A REHABase cohort study

Verdoux, Hélène; Quilès, Clélia; Cervello, Sophie; Dubreucq, Julien; Bon, Laura; Massoubre, Catherine; Pommier, Romain; Legros-Lafarge, Émilie; Jaafari, Nemat; Guillard-Bouhet, Nathalie; Chéreau-Boudet, I.; Couhet, Geoffroy; Plasse, Julien; Franck, Nicolás

doi:10.1016/j.psychres.2019.112543

Cited by 6 publications

(6 citation statements)

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“…In the current study, 12% of participants were prescribed antiparkinsonian drugs. In a previous study in the REHABase sample, we showed that the indications for antiparkinsonian drugs should be optimized in this population: 9% of clozapine users were prescribed such drugs, yet this co-prescription has no pharmacological rationale and increases the risk of potentially lethal adverse drug reactions (Verdoux et al, 2019). As highlighted in the current study, antiparkinsonian drugs represent only the tip of the iceberg of psychotropic drugs with anticholinergic activities prescribed to schizophrenia patients.…”

Section: Interpretation Of Findingsmentioning

confidence: 65%

“…The study was carried out in the REHABase cohort including persons with serious mental illness or autism spectrum disorder referred to the six centers of a French psychosocial rehabilitation network (Franck et al, 2019;Verdoux et al, 2019). The rehabilitation plan care proposed to these patients has already been fully described (Franck et al, 2019).…”

Section: Populationmentioning

confidence: 99%

“…The strength of the association between anticholinergic load and delayed-episodic memory was reduced (OR = 1.43, 95% CI 0.82-2.50, p = 0.21) whereas those of other associations were unchanged (stage of recovery: OR = 1.77, 95% CI 1.04-2.98, p = 0.03; mental well-being: OR = 1.49, 95% CI 0.96-2.30, p = 0.07; medication adherence: OR = 2.27, 95% CI 1.33-3.89, p = 0.003; multiple errands test completion time: OR = 0.59, 95% CI 0.37-0.96, p = 0.03). Second, we restricted the analyses to persons not exposed to clozapine use (n = 908) for comparable reasons (highanticholinergic activity and proxy of illness severity) (Verdoux et al, 2019). The strengths of the associations were unchanged (stage of recovery: OR = 1.78, 95% CI 1.04-3.01, p = 0.03; mental well-being: OR = 1.56, 95% CI 1.0-2.43, p = 0.05; medication adherence: OR = 2.23, 95% CI 1.31-3.79, p = 0.003; delayed-episodic memory: OR = 1.74, 95% CI 0.99-3.07, p = 0.05); multiple errands test completion time: OR = 0.60, 95% CI 0.38-0.95, p = 0.03).…”

Section: Impact Of Anticholinergic Load On Functioning and Cognitionmentioning

confidence: 99%

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Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers

et al. 2020

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Background Few studies have explored whether high-anticholinergic load may hamper rehabilitation in persons with schizophrenia. We aim to explore the associations between anticholinergic load of psychotropic treatment and functioning or cognitive performances of persons with psychosis engaged in psychosocial rehabilitation. Methods The study was performed using data collected at baseline assessment in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. The composite-rating scale developed by Salahudeen et al. was used to rate the anticholinergic load of psychotropic drugs prescribed at baseline assessment. The associations between total anticholinergic load score (categorized as ‘low’ <3 v. ‘high’ ⩾3) and functioning or cognitive characteristics were explored using multivariate analyses. Results Of the 1012 participants with schizophrenia spectrum disorders identified in the REHABase, half used at least two psychotropic drugs with anticholinergic activity and one out of three was prescribed at least one psychotropic drug with high-anticholinergic activity. High-anticholinergic load was significantly associated with lower stage of recovery [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.05–2.76, p = 0.03], poor mental well-being (OR = 1.55, 95% CI 1.02–2.33, p = 0.04) and poor self-rated medication adherence (OR = 2.14, 95% CI 1.29–3.53, p = 0.003). Regarding cognition, a high-anticholinergic score was associated with poorer delayed-episodic memory (OR = 1.69, 95% CI 1.01–2.85, p = 0.05) and at the trend level with faster completion time on the test exploring executive performance (OR = 0.67, 95% CI 0.43–1.04, p = 0.07). Conclusions The psychosocial rehabilitation plan of persons with psychosis should integrate optimization of psychotropic treatment in order to lessen the functional and cognitive impact of high-anticholinergic load.

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Section: Interpretation Of Findingsmentioning

confidence: 65%

Section: Populationmentioning

confidence: 99%

Section: Impact Of Anticholinergic Load On Functioning and Cognitionmentioning

confidence: 99%

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Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers

et al. 2020

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“…Innym problemem są obecne, nasilone zaburzenia funkcji poznawczych, które mogą być skutkiem ubocznym stosowanych elektrowstrzą sów, ale powodem generującym ww. zaburzenia mogą być również stosowane leki (cholinolityczne, sedujące działanie klozapiny) oraz sam proces schizofreniczny, w trakcie którego może dochodzić do znacznego upo śledzenia funkcji poznawczych [9][10][11][12].…”

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Catatonic schizophrenia as a persistent therapeutic challenge – a case report

Izdebski¹,

Świerzy²,

Błachut³

et al. 2020

ppn

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“…The property of clozapine as a 5‐HT 6 receptor antagonist may play a role in potentially promoting cognition through regulating dopaminergic transmission in the frontal cortex and increasing cholinergic activity in the hippocampus (Lameh et al, 2007; Shirazi‐Southall, Rodriguez, & Nomikos, 2002). However, the effects of clozapine on cognition continue to vary across studies from inconsistent results to amelioration, impairment, or no effect (Lindenmayer et al, 1998; Simosky, Stevens, Adler, & Freedman, 2003; Thornton, Van Snellenberg, Sepehry, & Honer, 2006; Verdoux et al, 2019). The researchers attempted to explain these inconsistent conclusions by the pharmacodynamic properties of N‐Desmethylclozapine (NDMC).…”

Section: Introductionmentioning

confidence: 99%

Differential effects of different antipsychotic drugs on cognitive function in patients with chronic schizophrenia

Dong

Yuan

Yong

et al. 2020

Human Psychopharmacology

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Background Cognitive impairment is core feature of schizophrenia. The impact of antipsychotics on cognition remains controversial. This study aimed to examine the effects of long‐term use of different types of antipsychotics on cognitive impairment in schizophrenia patients. Methods We used the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to assess the cognition of three groups of schizophrenia patients (318 on clozapine, 125 on risperidone, and 166 on typical antipsychotic drugs) and 399 healthy controls, and used the Positive and Negative Syndrome Scale to assess schizophrenia symptoms of patients. Results Patients taking typical antipsychotics scored higher on the immediate memory and delayed memory index than those taking clozapine or risperidone (all p < 0.01). Patients taking clozapine scored higher on the language subscale than those taking risperidone (p < 0.05). Multiple regression analysis showed that the drug type was identified as an independent contributor to the immediate memory, language, and delayed memory index of RBANS (all p < 0.05). Conclusions Patients taking typical antipsychotics have better memory than those taking clozapine or risperidone. Patients taking clozapine have better language function than those taking risperidone.

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Functioning and cognitive characteristics of clozapine users referred to psychosocial rehabilitation centers: A REHABase cohort study

Cited by 6 publications

References 47 publications

Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers

Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers

Catatonic schizophrenia as a persistent therapeutic challenge – a case report

Differential effects of different antipsychotic drugs on cognitive function in patients with chronic schizophrenia

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