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Anticholinergic Burden in People With Learning Disability and Mental Health Difficulties: A Baseline Audit

Published online by Cambridge University Press:  01 August 2024

Sreeja Sahadevan*
Affiliation:
Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom
Melissa Hicks
Affiliation:
Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom
Reena Tharian
Affiliation:
Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom
Elizabeth Patteril
Affiliation:
Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom
Regi Alexander
Affiliation:
Little Plumstead Hospital, Hertfordshire Partnership University NHS Foundation Trust, Norwich, United Kingdom
*
*Presenting author.
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Abstract

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Aims

Background:

The cumulative effect of having one or more prescription drugs with anticholinergic properties is known as the Anticholinergic Burden (ACB). ACB can increase mortality and morbidity. Adults with learning disability are a high-risk group for this.

Aims:

To evaluate Anticholinergic Burden (ACB) for adults with learning disability and co-existing mental health conditions and make practice recommendations.

Methods

A baseline audit was carried out over a period of 1 month on those treated within two specialist in-patient units in England. Routinely collected information including diagnosis, prescribed medication, clinical outcomes (Clinical Global Impression – CGI) and side-effect scales (ACB calculator, Anticholinergic Effect on Cognition – AEC, Liverpool University Neuroleptic Side-effect Rating Scale – LUNSERS, Glasgow Antipsychotic Side-effect Scale – GASS) were collated and analyzed using quantitative methods.

Results

19 patients were included. Mean age was 37 years, 89% (n = 17) were male and 95% (n = 18) of white British ethnicity. The clinical diagnoses included 74% (n = 14) with mild learning disability, 68% (n = 13) with a major mental illness (psychosis or affective disorder), 53% (n = 10) with autism and 32 (n = 6) with a personality disorder. 89% (n = 17) were on antipsychotics, 63% (n = 12) on mood stabilizers, 58% (n = 11) on antimuscarinic drugs for antipsychotic side effects, 58% (n = 11) on anxiolytics, 32% (n = 6) on antidepressants and 89% (n = 17) on medication for physical conditions. Including pro re nata (prn) medication, the mean ACB calculator score was 6.68 and 4.21 on the AEC scale. On LUNSERS, the mean score was 23.13 (medium side effects), on GASS 8.87 (mild or absent side effects), on CGI efficacy index 6 (decided clinical improvement with side-effects not significantly interfering with functioning) and on CGI global improvement 2.37 (much improved).

Conclusion

The ACB in people with learning disability and mental health problems is high. While an ACB calculator score of 3+ is described as associated with increased mortality and morbidity in the general population, the mean score in this sample was double that if prescribed prn medication was included. Medication prescribed for both mental and physical health reasons. Despite the high ACB, they show good clinical improvement and functioning regarding their mental health. The scores on other side effect scales are not exceedingly high either. There is a need for more research to set the specific practice standards regarding ACB measurement and monitoring in this group. Adequate health education for patients and staff should be a priority to maintain vigilance regarding ACB effects.

Type
5 Audit
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

Footnotes

Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.

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