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Martínez-Cao C, García-Fernández A, González-Blanco L, Sáiz PA, Bobes J, García-Portilla MP. Anticholinergic load: A commonly neglected and preventable risk to cognition during schizophrenia treatment? Schizophr Res Cogn 2024; 37:100317. [PMID: 38745931 PMCID: PMC11092394 DOI: 10.1016/j.scog.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Background Cognitive impairment is a widespread feature of schizophrenia, affecting nearly 80 % of patients. Prior research has linked the anticholinergic burden of psychiatric medications to these cognitive deficits. However, the impact of the anticholinergic burden from medications for physical morbidity remains underexplored. This study aimed to evaluate the anticholinergic burden of psychiatric and physical medications in patients with schizophrenia and assess its impact on cognitive function. Methods A total of 178 patients with schizophrenia were recruited. The assessments included an ad hoc questionnaire for collecting demographic and clinical data. Anticholinergic burden was evaluated using the cumulative Drug Burden Index (cDBI) for each participant, and cognitive function was assessed using MATRICS. Psychopathology was measured using the PANSS, CDSS, CAINS, and the CGI-S. Statistical analysis included Student's t-tests, ANOVA, Pearson correlations, and multiple linear regressions. Results The average cDBI was 1.3 (SD = 0.9). The model developed explained 40.80 % of the variance. The variable with the greatest weight was the cDBI (B = -11.148, p = 0.010). Negative-expression (B = -2.740, p = 0.011) and negative-experiential (B = -1.175, p = 0.030) symptoms were also associated with lower global cognitive score. However, more years of education (B = 5.140, p < 0.001) and cigarettes per day (B = 1.331, p < 0.001) predicted a better global cognitive score. Conclusion This study identified specific predictors of global cognition in schizophrenia, with anticholinergic burden emerging as the strongest factor. Our findings underscore the importance of considering the anticholinergic burden of treatments, in addition to negative symptoms, when designing interventions to optimize or maintain cognitive function in patients with schizophrenia.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- University Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Spain
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Vidal N, Roux P, Urbach M, Belmonte C, Boyer L, Capdevielle D, Clauss-Kobayashi J, D’Amato T, Dassing R, Dubertret C, Dubreucq J, Fond G, Honciuc RM, Leignier S, Llorca PM, Mallet J, Misdrahi D, Pignon B, Rey R, Schürhoff F, Tessier A, Passerieux C, Brunet-Gouet E. Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment in schizophrenia: results from the multicenter FACE-SZ cohort. Front Pharmacol 2024; 15:1403093. [PMID: 38933674 PMCID: PMC11200119 DOI: 10.3389/fphar.2024.1403093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Aim The anticholinergic properties of medications are associated with poorer cognitive performance in schizophrenia. Numerous scales have been developed to assess anticholinergic burden and yet, there is no consensus indicating which anticholinergic burden scale is more relevant for patients with schizophrenia. We aimed to identify valid scales for estimating the risk of iatrogenic cognitive impairment in schizophrenia. Methods We identified 27 scales in a literature review. The responses to neuropsychological tests of 839 individuals with schizophrenia or schizoaffective disorder in the FACE-SZ database were collected between 2010 and 2021. We estimated the association between objective global cognitive performance and the 27 scales, the number of psychotropic drugs, and chlorpromazine and lorazepam equivalents in bivariable regressions in a cross-sectional design. We then adjusted the bivariable models with covariates: the predictors significantly associated with cognitive performance in multiple linear regressions were considered to have good concurrent validity to assess cognitive performance. Results Eight scales, the number of psychotropic drugs, and drug equivalents were significantly associated with cognitive impairment. The number of psychotropic drugs, the most convenient predictor to compute, was associated with worse executive function (Standardized β = -0.12, p = .004) and reasoning (Standardized β = -0.08, p = .037). Conclusion Anticholinergic burden, the number of psychotropic drugs, and drug equivalents were weakly associated with cognition, thus suggesting that cognitive impairment in schizophrenia and schizoaffective disorder is explained by factors other than medication. The number of psychotropic drugs was the most parsimonious method to assess the risk of iatrogenic cognitive impairment.
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Affiliation(s)
- Nathan Vidal
- FondaMental Foundation, Créteil, France
- Centre Hospitalier de Versailles, Service universitaire de psychiatrie d’adultes et d’addictologie, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
| | - Paul Roux
- FondaMental Foundation, Créteil, France
- Centre Hospitalier de Versailles, Service universitaire de psychiatrie d’adultes et d’addictologie, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
| | - Mathieu Urbach
- FondaMental Foundation, Créteil, France
- Centre Hospitalier de Versailles, Service universitaire de psychiatrie d’adultes et d’addictologie, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
| | - Cristobal Belmonte
- FondaMental Foundation, Créteil, France
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, Montpellier, France
| | - Laurent Boyer
- FondaMental Foundation, Créteil, France
- EA 3279: Department of Epidemiology and Health Economics, School of Medicine—La Timone Medical Campus, Marseille University Hospital, Aix-Marseille University, Marseille, France
| | - Delphine Capdevielle
- FondaMental Foundation, Créteil, France
- University Department of Adult Psychiatry, Hospital La Colombière, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
| | - Julie Clauss-Kobayashi
- FondaMental Foundation, Créteil, France
- Department of Psychiatry, University Hospitals of Strasbourg, University of Strasbourg, Institut National de la Santé et de la Recherche Médicale (INSERM), Strasbourg, France
| | - Thierry D’Amato
- FondaMental Foundation, Créteil, France
- Le Vinatier Hospital, Schizophrenia Expert Centre, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France
| | - Romane Dassing
- FondaMental Foundation, Créteil, France
- Department of Psychiatry, University Hospitals of Strasbourg, University of Strasbourg, Institut National de la Santé et de la Recherche Médicale (INSERM), Strasbourg, France
| | - Caroline Dubertret
- FondaMental Foundation, Créteil, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Psychiatry, Louis Mourier Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Julien Dubreucq
- FondaMental Foundation, Créteil, France
- Grenoble Alpes University, Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Guillaume Fond
- FondaMental Foundation, Créteil, France
- EA 3279: Department of Epidemiology and Health Economics, School of Medicine—La Timone Medical Campus, Marseille University Hospital, Aix-Marseille University, Marseille, France
| | - Roxana-Mihaela Honciuc
- FondaMental Foundation, Créteil, France
- CHU Clermont-Ferrand, Service of psychiatry B, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Sylvain Leignier
- FondaMental Foundation, Créteil, France
- Grenoble Alpes University, Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Pierre-Michel Llorca
- FondaMental Foundation, Créteil, France
- CHU Clermont-Ferrand, Service of psychiatry B, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Jasmina Mallet
- FondaMental Foundation, Créteil, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Department of Psychiatry, Louis Mourier Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Psychiatry and Neuroscience of Paris, University Paris Descartes, Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - David Misdrahi
- FondaMental Foundation, Créteil, France
- Department of Universitary and General Psychiatry, Charles Perrens Hospital, University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA, ECOPSY), Bordeaux, France
| | - Baptiste Pignon
- FondaMental Foundation, Créteil, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Médicale (IMRB), Translational Neuropsychiatry, University Paris-Est-Créteil (UPEC), Créteil, France
| | - Romain Rey
- FondaMental Foundation, Créteil, France
- Le Vinatier Hospital, Schizophrenia Expert Centre, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), University Lyon 1, Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France
| | - Franck Schürhoff
- FondaMental Foundation, Créteil, France
- Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Médicale (IMRB), Translational Neuropsychiatry, University Paris-Est-Créteil (UPEC), Créteil, France
| | - Arnaud Tessier
- FondaMental Foundation, Créteil, France
- Department of Universitary and General Psychiatry, Charles Perrens Hospital, University of Bordeaux, Aquitaine Institute for Cognitive and Integrative Neuroscience (CNRS UMR 5287-INCIA, ECOPSY), Bordeaux, France
| | - Christine Passerieux
- FondaMental Foundation, Créteil, France
- Centre Hospitalier de Versailles, Service universitaire de psychiatrie d’adultes et d’addictologie, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
| | - Eric Brunet-Gouet
- FondaMental Foundation, Créteil, France
- Centre Hospitalier de Versailles, Service universitaire de psychiatrie d’adultes et d’addictologie, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
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Verdoux H, Quiles C, de Leon J. Optimizing antidepressant and clozapine co-prescription in clinical practice: A systematic review and expert recommendations. Schizophr Res 2024; 268:243-251. [PMID: 37852856 DOI: 10.1016/j.schres.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To synthesize the information relevant for clinical practice on clozapine-antidepressant co-prescription concerning pharmacokinetic drug-drug interactions (DDI), adverse drug reactions (ADRs) associated with the co-prescription, antidepressant add-on for clozapine-resistant symptoms and antidepressant add-on for clozapine-induced ADRs. METHODS Articles were identified with MEDLINE, Web of Sciences and PsycINFO search from inception through April 2023. Data were synthesized narratively. RESULTS ADRs are most often induced by the co-prescription of antidepressants that inhibit CYP enzymes (fluvoxamine, fluoxetine, paroxetine). Fluvoxamine add-on is hazardous because of its potent inhibition of clozapine metabolism and has few indications (lowering daily number of clozapine tablets, reducing norclozapine-induced metabolic disturbances and other dose-dependent clozapine-induced ADRs). ADR frequency may be reduced by therapeutic drug monitoring and knowledge of other factors impacting clozapine metabolism (pneumonia, inflammation, smoking, etc.). Improvement of negative symptoms is the most documented beneficial effect of antidepressant add-on for clozapine-resistant psychotic symptoms. The add-on antidepressant should be chosen according to its safety profile regarding DDI with clozapine: antidepressants inhibiting clozapine metabolism or increasing the anticholinergic load should be avoided. Other indications of antidepressant add-on (affective or obsessive compulsive symptoms, sialorrhea, and enuresis) are poorly documented. CONCLUSION Antidepressant add-on to clozapine is associated with potential benefits in clozapine users as this strategy may contribute to reduce the burden of clozapine-resistant symptoms or of clozapine-induced ADRs. Further studies are needed to determine whether antidepressant add-on can reduce the risk of clozapine discontinuation.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.
| | - Clélia Quiles
- Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, Psychiatry and Neurosciences Research Group (CTS-549), USA; Institute of Neurosciences, University of Granada, Granada, Spain; Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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4
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Peralta V, de Jalón EG, Moreno-Izco L, Peralta D, Janda L, Sánchez-Torres AM, Cuesta MJ. The effect of anticholinergic burden of psychiatric medications on major outcome domains of psychotic disorders: A 21-year prospective cohort study. Schizophr Res 2024; 264:386-393. [PMID: 38237360 DOI: 10.1016/j.schres.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 < 0.001) and poor cognitive performance (β = -0.273, p < 0.001). This association pattern was independent of a schizophrenia diagnosis. Most of the associations between ACB at the follow-up visit and the outcomes were accounted for ACB-years exposure. CONCLUSION Lifetime ACB of psychotropic medications has deleterious effects on the outcome of psychotic disorders. Clinicians should avoid prescribing medications with strong ACB, since there are numerous alternatives within each psychotropic drug group for prescribing medications with low ACB.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
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5
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Allott K, Yuen HP, Baldwin L, O'Donoghue B, Fornito A, Chopra S, Nelson B, Graham J, Kerr MJ, Proffitt TM, Ratheesh A, Alvarez-Jimenez M, Harrigan S, Brown E, Thompson AD, Pantelis C, Berk M, McGorry PD, Francey SM, Wood SJ. Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial. Transl Psychiatry 2023; 13:199. [PMID: 37301832 DOI: 10.1038/s41398-023-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ; ACTRN12607000608460).
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University College Dublin, Belfield, Ireland
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Sidhant Chopra
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Melissa J Kerr
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Global and Population Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew D Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Michael Berk
- Orygen, Parkville, VIC, Australia
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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Barbalat G, Plasse J, Gauthier E, Verdoux H, Quiles C, Dubreucq J, Legros-Lafarge E, Jaafari N, Massoubre C, Guillard-Bouhet N, Haesebaert F, Franck N. The central role of self-esteem in the quality of life of patients with mental disorders. Sci Rep 2022; 12:7852. [PMID: 35550549 PMCID: PMC9098638 DOI: 10.1038/s41598-022-11655-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
Abstract
In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem–Physical Well-Being, Self-Esteem–Autonomy, Self-Esteem–Psychological Well-Being, and Self-Esteem–Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-group tests did not reveal any differences regarding network structure, overall connectivity, edge-weights, and nodes’ centrality. Despite presenting with different symptom profiles, various psychiatric disorders may demonstrate similar inter-relationships among quality-of-life dimensions. In particular, self-esteem may have a crucial inter-connecting role in patients’ quality of life. Our findings could support treatment programmes that specifically target self-esteem to improve patients’ quality of life in a cost-effective way.
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Affiliation(s)
- Guillaume Barbalat
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, UMR 5229, CNRS & Claude Bernard Unversity Lyon 1, Université de Lyon, Lyon, France.
| | - Julien Plasse
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, UMR 5229, CNRS & Claude Bernard Unversity Lyon 1, Université de Lyon, Lyon, France
| | - Emmanuel Gauthier
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, UMR 5229, CNRS & Claude Bernard Unversity Lyon 1, Université de Lyon, Lyon, France
| | | | | | - Julien Dubreucq
- Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
| | | | | | | | | | - Frédéric Haesebaert
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, UMR 5229, CNRS & Claude Bernard Unversity Lyon 1, Université de Lyon, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, Pôle Centre rive gauche, UMR 5229, CNRS & Claude Bernard Unversity Lyon 1, Université de Lyon, Lyon, France
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Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry 2022; 13:970210. [PMID: 36117655 PMCID: PMC9476599 DOI: 10.3389/fpsyt.2022.970210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.
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Affiliation(s)
| | | | | | | | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
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Verdoux H, Quiles C, Bon L, Chéreau-Boudet I, Dubreucq J, Legros-Lafarge E, Guillard-Bouhet N, Massoubre C, Plasse J, Franck N. Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers. Eur Arch Psychiatry Clin Neurosci 2021; 271:1415-1424. [PMID: 33169212 DOI: 10.1007/s00406-020-01207-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.
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Affiliation(s)
- Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000, Bordeaux, France. .,Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, 33000, Bordeaux, France. .,Hôpital Charles Perrens, 121 rue de la Bechade, 33076, Bordeaux Cedex, France.
| | - Clélia Quiles
- Centre Référent de Réhabilitation Psychosociale (C2RP), Centre Hospitalier Charles Perrens, 33000, Bordeaux, France
| | - Laura Bon
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France
| | - Isabelle Chéreau-Boudet
- Centre Référent Conjoint de Réhabilitation (CRCR), Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Julien Dubreucq
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère/Réseau Handicap Psychique, St Martin d'Hères, France.,ReHPSY, Centre Hospitalier Alpes Isère, Grenoble, France
| | | | | | - Catherine Massoubre
- REHALise, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Julien Plasse
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive (CRR), Hôpital Le Vinatier, Centre National de la Recherche Scientifique (CNRS) et Université Claude Bernard, Lyon 1, Lyon, France.,Pôle Centre rive gauche, Centre Hospitalier Le Vinatier, Lyon, France
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Principes et outils de la réhabilitation psychosociale. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Taylor-Rowan M, Edwards S, Noel-Storr AH, McCleery J, Myint PK, Soiza R, Stewart C, Loke YK, Quinn TJ. Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome. Cochrane Database Syst Rev 2021; 5:CD013540. [PMID: 34097766 PMCID: PMC8169439 DOI: 10.1002/14651858.cd013540.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Medications with anticholinergic properties are commonly prescribed to older adults. The cumulative anticholinergic effect of all the medications a person takes is referred to as the 'anticholinergic burden' because of its potential to cause adverse effects. It is possible that high anticholinergic burden may be a risk factor for development of cognitive decline or dementia. There are various scales available to measure anticholinergic burden but agreement between them is often poor. OBJECTIVES To assess whether anticholinergic burden, as defined at the level of each individual scale, is a prognostic factor for future cognitive decline or dementia in cognitively unimpaired older adults. SEARCH METHODS We searched the following databases from inception to 24 March 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), and ISI Web of Science Core Collection (ISI Web of Science). SELECTION CRITERIA We included prospective and retrospective longitudinal cohort and case-control observational studies with a minimum of one year' follow-up that examined the association between an anticholinergic burden measurement scale and future cognitive decline or dementia in cognitively unimpaired older adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, and undertook data extraction, assessment of risk of bias, and GRADE assessment. We extracted odds ratios (OR) and hazard ratios, with 95% confidence intervals (CI), and linear data on the association between anticholinergic burden and cognitive decline or dementia. We intended to pool each metric separately; however, only OR-based data were suitable for pooling via a random-effects meta-analysis. We initially established adjusted and unadjusted pooled rates for each available anticholinergic scale; then, as an exploratory analysis, established pooled rates on the prespecified association across scales. We examined variability based on severity of anticholinergic burden. MAIN RESULTS We identified 25 studies that met our inclusion criteria (968,428 older adults). Twenty studies were conducted in the community care setting, two in primary care clinics, and three in secondary care settings. Eight studies (320,906 participants) provided suitable data for meta-analysis. The Anticholinergic Cognitive Burden scale (ACB scale) was the only scale with sufficient data for 'scale-based' meta-analysis. Unadjusted ORs suggested an increased risk for cognitive decline or dementia in older adults with an anticholinergic burden (OR 1.47, 95% CI 1.09 to 1.96) and adjusted ORs similarly suggested an increased risk for anticholinergic burden, defined according to the ACB scale (OR 2.63, 95% CI 1.09 to 6.29). Exploratory analysis combining adjusted ORs across available scales supported these results (OR 2.16, 95% CI 1.38 to 3.38), and there was evidence of variability in risk based on severity of anticholinergic burden (ACB scale 1: OR 2.18, 95% CI 1.11 to 4.29; ACB scale 2: OR 2.71, 95% CI 2.01 to 3.56; ACB scale 3: OR 3.27, 95% CI 1.41 to 7.61); however, overall GRADE evaluation of certainty of the evidence was low. AUTHORS' CONCLUSIONS There is low-certainty evidence that older adults without cognitive impairment who take medications with anticholinergic effects may be at increased risk of cognitive decline or dementia.
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Affiliation(s)
- Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Phyo K Myint
- Division of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Roy Soiza
- Department of General Internal Medicine, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Yoon Kong Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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