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

• Published in: Schizophrenia research 2024-02, Vol.264, p.386-393
• Main Authors: Peralta, Victor, de Jalón, Elena García, Moreno-Izco, Lucía, Peralta, David, Janda, Lucía, Sánchez-Torres, Ana M., Cuesta, Manuel J.
• Format: Article
• Language: English
• Subjects: Anticholinergic burden; Cognition; Negative symptoms; Outcome; Psychosis; Psychosocial functioning
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2024.01.020

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. 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. 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