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

Published online by Cambridge University Press:  22 May 2020

Hélène Verdoux Open the ORCID record for Hélène Verdoux [Opens in a new window] ,
Clélia Quiles ,
Laura Bon ,
Isabelle Chéreau-Boudet ,
Julien Dubreucq ,
Lucia Fiegi ,
Nathalie Guillard-Bouhet ,
Catherine Massoubre ,
Julien Plasse  and
Nicolas Franck
Hélène Verdoux*
Affiliation:
Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000Bordeaux, France Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, F-33000Bordeaux, France
Clélia Quiles
Affiliation:
Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, F-33000Bordeaux, France
Laura Bon
Affiliation:
Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France
Isabelle Chéreau-Boudet
Affiliation:
Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
Julien Dubreucq
Affiliation:
Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère/Réseau Handicap Psychique, St Martin d'Hères; ReHPSY, Centre Hospitalier Alpes Isère, Grenoble, France
Lucia Fiegi
Affiliation:
CREATIV & URC Pierre Deniker, Centre Hospitalier Laborit, Poitiers, France
Nathalie Guillard-Bouhet
Affiliation:
Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Limoges, France
Catherine Massoubre
Affiliation:
REHALise, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
Julien Plasse
Affiliation:
Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France
Nicolas Franck
Affiliation:
Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université de Lyon, Lyon, France Centre Référent Lyonnais de Réhabilitation Psychosociale (CL3R), Centre Hospitalier Le Vinatier, Lyon, France
*
Author for correspondence: Hélène Verdoux, E-mail: [email protected]
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Abstract

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.

Keywords

Anticholinergiccognitionfunctional outcomepsychosocial rehabilitationquality of life
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 16 , December 2021 , pp. 2789 - 2797
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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