Exploring Anticholinergic Burden in a Psychiatric Inpatient Population

Many psychiatric inpatients are prescribed complex medication regimens that include both psychiatric and medical drugs with high anticholinergic (ACH) activity. The cumulative ACH burden (ACB), arising from the pharmacodynamic additive effects of concomitant medication use, has been linked to a range of adverse effects. These include both short-term effects and long-term consequences. Our study aims to determine the degree of ACB in a psychiatric inpatient hospital using current measurement assessment tools.

This retrospective, observational study collected medication regimens and demographic data from the electronic health records of psychiatric inpatients. We included 250 adults aged 18 years or older who were institutionalized in a psychiatric hospital. The ACB was assessed using the ACH toxicity score (ATS), with data collected at two distinct time points, one in the spring and another in the winter, from different calendar years. The total ACB for both psychiatric and medical medications was compared across the patient population, analyzing the potential seasonal variation in the cumulative burden.

The degree of total ACB was not statistically significantly different (P=0.526) between the seasonal cohorts and remained consistent with an average total ATS of 8. An ATS score of 5 or higher is assumed to be clinically significant, with 75% of patients (93/124) and 78.6% (99/126) having shown significant burden in the winter and spring cohorts, respectively.

The prescribing of ACH medication did not significantly vary seasonally, however, most patients observed showed significant and consistent levels of ACB. It is recommended that clinicians should consider monitoring ACB in their prescribed regimens and consider pharmacologic strategies to reduce ACB. Risk reduction strategies include discontinuation of nonessential ACH medications or consideration of therapeutic interchange with an alternative agent with a lesser ACH profile. The deprescribing of long-term ACH medications for individuals who are otherwise clinically stable may improve both clinical outcomes and quality of life.