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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：大多数用于治疗精神病的药物具有抗胆碱能特性。这可能导致相当大的抗胆碱能负荷（ACB），这可能对长期结果产生有害影响。精神药物治疗多年累积ACB对不同结局领域的影响程度尚不清楚。
方法：这是一项针对243名首发精神病患者的自然主义研究，目的是检查在平均21年随访后，在整个病程（ACB年暴露）中服用的ACB对几个结局领域的累积影响。通过使用分层线性回归分析，对ACB与结果之间的关联进行建模，以考虑相关的混杂因素。
结果：在研究期间，81.9%的参与者被分配了至少一种具有强抗胆碱能作用的药物至少1年;在随访中,60.5%的参与者继续服用具有强ACB的药物。ACB年暴露与阴性症状的严重程度独特相关（β=0.144，p=0.004），不良的心理社会功能（β=0.186，p<0.001）和不良的认知表现（β=-0.273，p<0.001）。这种关联模式与精神分裂症的诊断无关。随访中的ACB与结果之间的大多数关联都是由于ACB年暴露所致。
结论：精神药物的终生ACB对精神障碍的结局有有害影响。临床医生应避免处方具有强ACB的药物，因为每个精神药物组中都有许多替代药物来处方低ACB的药物。
方法：这是一项针对243名首发精神病患者的自然主义研究，目的是检查在平均21年随访后，在整个病程（ACB年暴露）中服用的ACB对几个结局领域的累积影响。通过使用分层线性回归分析，对ACB与结果之间的关联进行建模，以考虑相关的混杂因素。
结果：在研究期间，81.9%的参与者被分配了至少一种具有强抗胆碱能作用的药物至少1年;在随访中,60.5%的参与者继续服用具有强ACB的药物。ACB年暴露与阴性症状的严重程度独特相关（β=0.144，p=0.004），不良的心理社会功能（β=0.186，p<0.001）和不良的认知表现（β=-0.273，p<0.001）。这种关联模式与精神分裂症的诊断无关。随访中的ACB与结果之间的大多数关联都是由于ACB年暴露所致。
结论：精神药物的终生ACB对精神障碍的结局有有害影响。临床医生应避免处方具有强ACB的药物，因为每个精神药物组中都有许多替代药物来处方低ACB的药物。
