3501 Forbes Ave, Ste 756, Pittsburgh, PA 15213.
Western Psychiatric Institute and Clinic of UPMC, Pittsburgh, Pennsylvania, USA.
J Clin Psychiatry. 2017 Nov/Dec;78(9):e1270-e1275. doi: 10.4088/JCP.16m11269.
Anticholinergic medications are prescribed to treat extrapyramidal side effects (EPS) associated with antipsychotics. Anticholinergic medications cause several side effects and can often be withdrawn during the maintenance phase of antipsychotic treatment without EPS reemergence. The purpose of this quality improvement (QI) project was to reduce anticholinergic medication burden and improve quality of life in patients with severe mental illness.
Patients with DSM-IV-TR-diagnosed schizophrenia, schizoaffective disorder, and bipolar disorders in an outpatient psychiatric clinic who were prescribed benztropine were identified, screened for anticholinergic side effects by the treating psychiatrist, and referred to an on-site clinical pharmacist for a comprehensive medication review. Anticholinergic side effects, cognitive impairment, and impact on quality of life were assessed using a Likert scale. Recommendations for potential medication changes were discussed with the prescriber. Initial and follow-up assessments were conducted over 1-8 months to identify improvements in side effects and quality of life.
Twenty-nine patients were assessed from November 2014 to December 2015. Patients were receiving from 1 to 6 medications with anticholinergic properties (median = 3 medications). Of the 29 patients, 19 were recommended for a medication change, with 13 having 1 or more anticholinergic medications discontinued and 6 having the dose decreased. A significant reduction in anticholinergic side effects and improvements in memory and quality of life were observed for these patients (P ≤ .05).
In this interdisciplinary, collaborative QI project, patients whose anticholinergic burden was reduced experienced a significant improvement in side effects, memory, and quality of life.
抗胆碱能药物被开处方用于治疗与抗精神病药物相关的锥体外系副作用（EPS）。抗胆碱能药物会引起多种副作用，并且在抗精神病药物治疗的维持阶段，通常可以在没有 EPS 再次出现的情况下停药。本质量改进（QI）项目的目的是减轻患有严重精神疾病的患者的抗胆碱能药物负担并提高其生活质量。
在一个门诊精神科诊所中，识别出符合 DSM-IV-TR 诊断的精神分裂症、分裂情感障碍和双相情感障碍的患者，由主治精神病医生筛查抗胆碱能副作用，并转介给现场临床药师进行全面药物审查。使用李克特量表评估抗胆碱能副作用、认知障碍和对生活质量的影响。与处方医生讨论潜在药物变化的建议。在 1-8 个月内进行初始和随访评估，以确定副作用和生活质量的改善情况。
2014 年 11 月至 2015 年 12 月评估了 29 名患者。患者正在接受 1 至 6 种具有抗胆碱能特性的药物（中位数= 3 种药物）。在 29 名患者中，有 19 名患者被建议进行药物更改，其中 13 名患者停用了 1 种或多种抗胆碱能药物，6 名患者减少了剂量。这些患者的抗胆碱能副作用显著减少，记忆力和生活质量得到改善（P≤0.05）。
在这项跨学科、协作的 QI 项目中，减轻抗胆碱能负担的患者在副作用、记忆力和生活质量方面有显著改善。
