Exploring Anticholinergic Burden in a Psychiatric Inpatient Population.

Area of Science:

• Pharmacology
• Psychiatry
• Geriatrics

Background:

• Psychiatric inpatients frequently receive complex medication regimens.
• High anticholinergic (ACH) activity in medications contributes to cumulative anticholinergic burden (ACB).
• ACB is associated with adverse effects, impacting both short-term and long-term patient outcomes.

Purpose of the Study:

• To assess the degree of cumulative anticholinergic burden (ACB) in psychiatric inpatients.
• To evaluate the effectiveness of current measurement tools for ACB assessment.
• To investigate potential seasonal variations in ACB within this patient population.

Main Methods:

• Retrospective, observational study of 250 psychiatric inpatients.
• Data collected from electronic health records, including medication regimens and demographics.
• Anticholinergic burden assessed using the Anticholinergic Toxicity Score (ATS) at two seasonal time points.

Main Results:

• No statistically significant seasonal variation in total ACB was observed (P=0.526).
• The average total ATS was 8, indicating a clinically significant burden.
• A high percentage of patients (75-78.6%) exhibited significant ACB in both winter and spring cohorts.

Conclusions:

• Prescribing of anticholinergic medications did not significantly vary by season.
• Most psychiatric inpatients experience significant and consistent ACB.
• Clinicians should monitor ACB and implement strategies to reduce it, such as deprescribing or therapeutic interchange.