BackgroundFew 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.MethodsThe 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.ResultsOf 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).ConclusionsThe 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.

中文翻译：

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抗胆碱能负荷对转至心理社会康复中心的精神病患者的功能和认知表现的影响

背景很少有研究探讨高抗胆碱能负荷是否会妨碍精神分裂症患者的康复。我们的目的是探讨精神药物治疗的抗胆碱能负荷与参与心理社会康复的精神病患者的功能或认知表现之间的关联。方法该研究是使用 REHABase 队列基线评估时收集的数据进行的，其中包括法国心理社会康复网络的人员中心。Salahudeen 等人开发的综合评级量表。用于评估基线评估时处方的精神药物的抗胆碱能负荷。总抗胆碱能负荷评分（分类为“低”<3）之间的关联v.使用多变量分析探讨了“高”⩾3）和功能或认知特征。结果在 REHABase 中确定的 1012 名患有精神分裂症谱系障碍的参与者中，一半使用了至少两种具有抗胆碱能活性的精神药物，三分之一的人服用了至少一种具有高抗胆碱能活性的精神药物。高抗胆碱能负荷与较低的恢复阶段显着相关[比值比 (OR) = 1.70，95% 置信区间 (CI) 1.05–2.76，p= 0.03]，心理健康状况不佳（OR = 1.55，95% CI 1.02–2.33，p= 0.04）和自评药物依从性较差（OR = 2.14，95% CI 1.29–3.53，p= 0.003）。关于认知，高抗胆碱能评分与较差的延迟情景记忆相关（OR = 1.69，95% CI 1.01–2.85，p= 0.05），并且在探索执行绩效的测试中完成时间更快的趋势水平（OR = 0.67，95% CI 0.43–1.04，p= 0.07）。结论精神病患者的社会心理康复计划应整合精神药物治疗的优化，以减轻高抗胆碱能负荷对功能和认知的影响。