Briet Jeanne, Javelot Hervé, Heitzmann Edwige, Weiner Luisa, Lameira Catherine, D'Athis Philippe, Corneloup Marie, Vailleau Jean-Louis
Pharmacy service, CHS de La Chartreuse, 21000 Dijon, France; PIC network (Psychiatrie Information Communication), EPSM Lille-Métropole, 59487 Armentières, France.
PIC network (Psychiatrie Information Communication), EPSM Lille-Métropole, 59487 Armentières, France; Établissement public de santé Alsace Nord, 67170 Brumath, France.
Therapie. 2017 Sep;72(4):427-437. doi: 10.1016/j.therap.2016.12.010. Epub 2017 Feb 17.
Some drugs have anticholinergic activity and can cause peripheral or central side effects. Several scales exist to evaluate the potential anticholinergic effect of prescribed drugs but: (i) they are validated in the elderly and mainly assess the cognitive side effect of treatments; (ii) they do not concern some of the drugs frequently used in clinical psychiatry in France. The aim of our study is to develop a new scale, the anticholinergic impregnation scale (AIS), with drugs used in France and based on an assessment of the drugs used against peripheral anticholinergic adverse effects.
We assigned a score, ranging from 1 to 3, to a list of 128 drugs with a consensus approach obtained via literature data and expert opinions. We collected data from 7278 prescriptions in 34 French psychiatric facilities: age, sex, atropinic drugs, laxatives and treatments of xerophthalmia and xerostomia, in order to evaluate the association between AIS score and the prescription of drugs aiming to reduce peripheral anticholinergic side effects.
The most frequently prescribed drugs were cyamemazine (n=1429; 20%) and tropatepine (n=1403; 19%), two drugs marketed almost exclusively in France and with a score of 3. The frequency of patients with a high AIS score, greater than 5, was significantly higher in patients who received laxatives and treatments of xerostomia. AIS score represents the first validated solution to evaluate anticholinergic load in psychiatry settings in France.
The anticholinergic problem remains underevaluated in mental health settings. In order to rule out the confounding factor of mental disease, assessment of peripheral side effects can be considered more objective than the evaluation of cognitive function in psychiatric patients. Building scales appropriate for each state also appear essential to obtain an useful and effective tool in clinical practice.
一些药物具有抗胆碱能活性，可引起外周或中枢副作用。有几种量表可用于评估处方药的潜在抗胆碱能作用，但：（i）它们在老年人中得到验证，主要评估治疗的认知副作用；（ii）它们未涉及法国临床精神病学中常用的一些药物。我们研究的目的是开发一种新的量表，即抗胆碱能负荷量表（AIS），该量表基于法国使用的药物，并基于对用于对抗外周抗胆碱能不良反应的药物的评估。
我们通过文献数据和专家意见采用共识方法，为128种药物列表分配了1至3分的分数。我们收集了法国34家精神病机构7278份处方的数据：年龄、性别、阿托品类药物、泻药以及干眼症和口干症的治疗药物，以评估AIS评分与旨在减少外周抗胆碱能副作用的药物处方之间的关联。
最常开具的药物是氰美马嗪（n = 1429；20%）和托哌酮（n = 1403；19%），这两种药物几乎仅在法国销售，评分为3分。接受泻药和口干症治疗的患者中，AIS评分高于5分的患者频率显著更高。AIS评分是评估法国精神病学环境中抗胆碱能负荷的首个经过验证的解决方案。
抗胆碱能问题在心理健康环境中仍未得到充分评估。为了排除精神疾病的混杂因素，对外周副作用的评估可能比评估精神病患者的认知功能更客观。构建适合每种情况的量表对于在临床实践中获得有用且有效的工具似乎也至关重要。
