Reducing Anticholinergic Medication Burden in Patients With Psychotic or Bipolar Disorders

Lupu, Ana M.; Clinebell, Kimberly; Gannon, Jessica; Ellison, Justin C.; Chengappa, K. N. Roy

doi:10.4088/jcp.16m11269

Cited by 30 publications

(40 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Deprescription has the potential to reduce or eliminate unnecessary or potentially inadequate drugs, reduce polypharmacy and improve different health variables. Eliminating or reducing the anticholinergic load can improve cognition, adverse effects and quality of life (Lupu et al, 2017). For example, in patients with schizophrenia younger than 50 years, the discontinuation of anticholinergics improved the results in the Wisconsin Card Sorting Test, a measurement of executive dysfunction (Sathienluckana et al, 2018).…”

Section: Consequences Of Discontinuation Of Anticholinergic Drugsmentioning

confidence: 99%

“…Nonetheless, discontinuation is not always possible and clinical reasons for not carrying out the discontinuation should always be considered (Lupu et al, 2017). For example, in some patients with schizophrenia, withdrawing benztropine may clearly worsen extrapyramidal symptoms related to antipsychotic medication, and therefore maintenance of the treatment may be required.…”

Section: Consequences Of Discontinuation Of Anticholinergic Drugsmentioning

confidence: 99%

See 1 more Smart Citation

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

View full text Add to dashboard Cite

Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson’s disease, cardiovascular conditions and urinary incontinence.

show abstract

Section: Consequences Of Discontinuation Of Anticholinergic Drugsmentioning

confidence: 99%

Section: Consequences Of Discontinuation Of Anticholinergic Drugsmentioning

confidence: 99%

Anticholinergic Drugs in Geriatric Psychopharmacology

López-Álvarez¹,

Sevilla‐Llewellyn‐Jones

Agüera-Ortíz³

2019

Front. Neurosci.

View full text Add to dashboard Cite

show abstract

“…30,38,39,68 Outpatients in primary care, general mental health, and specialty clinics have improved medication safety (eg, reduction in anticholinergic burden, improved medication appropriateness) and reach therapeutic goals (eg, symptom reduction, fewer hospitalizations) at a higher rate when a pharmacist who is focused on CNS medications contributes to their care. 47,49,52,54,60,64,65 Patients filling prescriptions in community pharmacies have better access to long-acting injectable antipsychotic medications and increased medication adherence and are more satisfied with their medications when receiving pharmacist-delivered, psychiatry-focused interventions. [83][84][85][86] Patients seeking care for SUD experience increased access to buprenorphine-naloxone and naloxone, both life-saving medications, when a psychiatric pharmacist is involved in the SUD care setting.…”

Section: Resultsmentioning

confidence: 99%

“…* Some of the studies are underpowered to detect a difference and do not show statistically significant outcomes. 31,33,56,69,70,72 Psychiatric pharmacists also show statistically significant benefits on patient-level outcomes in at least 5 peer-reviewed publications by providing services, including medication reviews, patient education, à patient and/or data evaluation for medication safety and efficacy, 26,31,35,37,40,41,47 and independent management of medication therapy upon referral. 50,[76][77][78][79]81 Twenty (31.3%) of the included studies have at least 1 BCPP author with formal advanced training in psychiatry/ neurology.…”

Section: Resultsmentioning

confidence: 99%

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

Werremeyer

Bostwick

Cobb³

et al. 2020

Mental Health Clinician

View full text Add to dashboard Cite

Introduction Psychiatric and neurologic illnesses are highly prevalent and are often suboptimally treated. A 2015 review highlighted the value of psychiatric pharmacists in improving medication-related outcomes. There is a need to describe areas of expansion and strengthened evidence regarding pharmacist practice and patient care impact in psychiatric and neurologic settings since 2015. Methods A systematic search of literature published from January 2014 to June 2019 was conducted. Publications describing patient-level outcome results associated with pharmacist provision of care in a psychiatric/neurologic setting and/or in relation to central nervous system (CNS) medications were included. Results A total of 64 publications were included. There was significant heterogeneity of published study methods and data, prohibiting meta-analysis. Pharmacists practicing across a wide variety of health care settings with focus on CNS medication management significantly improved patient-level outcomes, such as medication adherence, disease control, and avoidance of hospitalization. The most common practice approach associated with significant improvement in patient-level outcomes was incorporation of psychiatric pharmacist input into the interprofessional health care team. Discussion Pharmacists who focus on psychiatric and neurologic disease improve outcomes for patients with these conditions. This is important in the current health care environment as most patients with psychiatric or neurologic conditions continue to have unmet needs. Additional studies designed to measure pharmacists' impact on patient-level outcomes are encouraged to strengthen these findings.

show abstract

“…Также не учитывался прием соматических препаратов с аналогичным эффектом. Тем не менее в современной литературе этот вопрос практически не обсуждается, а исследования о влиянии комбинации антипсихотиков и антихолинергических средств единичны [3,6,22].…”

Section: Discussionunclassified

Influence of clinical and therapeutic indicators on the severity of neurocognitive deficits in patients with schizophrenia

et al. 2020

View full text Add to dashboard Cite

РЕЗЮМЕ Цель. Оценить связь клинических и терапевтических показателей с выраженностью нейрокогнитивного дефицита у пациентов с шизофренией. Материалы и методы. Были обследованы 118 пациентов с шизофренией в возрасте 34 [29; 41] лет, с длительностью заболевания-10 [4; 16] лет. Конвенциональные антипсихотические препараты (КАП) получали 33 пациента (28%), атипичные антипсихотическое препараты (ААП)-85 (72%) пациентов. В качестве сопутствующей терапии 58 человек (49,1%) принимали тригексифенидил, не принимали его 60 человек (50,9%). Оценка когнитивных функций проведена всем пациентам по шкале краткой оценки когнитивных функций у пациентов с шизофренией (Brief Assessment of Cognition in Schizophrenia, BACS), клинико-психопатологической симптоматики-с использованием шкалы позитивных и негативных синдромов (Positive and Negative Syndrome Scale, PANSS). Статистический анализ полученных данных выполнен с использованием критерия Краскела-Уоллиса ANOVA с процедурой множественного сравнения, критерия χ2 Пирсона и кластерного анализа методом K-средних. Результаты. Нейрокогнитивный дефицит образовал три кластера нарушений, отличающихся между собой клинической выраженностью: 1) легкий, 2) умеренно выраженный, 3) выраженный. По субшкале позитивных симптомов PANSS пациенты с легким нейрокогнитивным дефицитом имели меньший средний суммарный балл по сравнению с больными с выраженным нейрокогнитивным дефицитом (p = 0,011), которые, в свою очередь, значимо дольше получали антипсихотическую терапию по сравнению с пациентами с умеренным (p = 0,014) и легким (p = 0,01) нейрокогнитивным дефицитом. При этом длительность приема КАП не различалась между кластерами, следовательно, имеющиеся результаты по антипсихотикам в целом получены за счет ААП (p = 0,005 и p = 0,001 соответственно). Тригексифенидил не оказал влияния на выраженность нейрокогнитивного дефицита. Заключение. Выраженность позитивных симптомов шизофрении была ниже у пациентов с легким нейрокогнитивным дефицитом. Наиболее выраженные нейрокогнитивные нарушения отмечаются у пациентов, получающих ААП. Ключевые слова: шизофрения, нейрокогнитивный дефицит, антипсихотики, тригексифенидил. Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.

show abstract

Reducing Anticholinergic Medication Burden in Patients With Psychotic or Bipolar Disorders

Abstract: In this interdisciplinary, collaborative QI project, patients whose anticholinergic burden was reduced experienced a significant improvement in side effects, memory, and quality of life.

Cited by 30 publications

References 0 publications

Anticholinergic Drugs in Geriatric Psychopharmacology

Anticholinergic Drugs in Geriatric Psychopharmacology

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders

Influence of clinical and therapeutic indicators on the severity of neurocognitive deficits in patients with schizophrenia

Contact Info

Product

Resources

About