Medication data were retrieved from the medical records of participants. It included mainly antipsychotics, mood stabilizers, benzodiazepines, anticholinergics, and antidepressants.
Mood stabilizers comprised lithium carbonate and antiepileptic medications (valproic acid, carbamazepine, pregabalin, topiramate, and phenytoin). The benzodiazepines included lorazepam, clonazepam, alprazolam, diazepam, alprazolam, and bromazepam. Anticholinergics consisted of trihexyphenidyl. Antidepressants were divided into two groups, i.e., tricyclic antidepressants (TCA, including amitriptyline, clomipramine, and imipramine) and other antidepressants (venlafaxine, sertraline).
The total anticholinergic burden was calculated based on the updated version of the Anticholinergic Drug Scale (ADS), where each medication was assigned a numerical value from 0 to 3, depending on their anticholinergic strength, and the overall ADS score for a patient was calculated by summing the values of all scheduled medications used by each participant [28 (link)]. This scale is the most comprehensive currently available for quantifying the anticholinergic burden for most medicines used to treat psychotic symptoms [28 (link)].
Serum anticholinergic activity (SAA) is considered the current gold standard in quantifying anticholinergic burden [28 (link)]. However, it is only quantified in a small number of research laboratories. An ADS scale might help determine who is the most at risk for adverse side effects and offer guidance in interventions [28 (link)]. Previous studies have shown that the ADS score was significantly associated with SAA, suggesting it is a helpful tool for assessing anticholinergic burden [28 (link), 38 (link)]. However, using ADS ratings to classify medications is a method of limited accuracy since there will be variations in anticholinergic potencies across medications within each group, regardless of the accuracy of the classification. Also, SAA might be influenced by endogenous substances, which are not measurable by the ADS scale, which only evaluates anticholinergic characteristics of medications.
Furthermore, antipsychotic medications were divided into second-generation antipsychotics or SGA (risperidone, clozapine, olanzapine, quetiapine, and paliperidone) and first-generation antipsychotics or FGA (haloperidol, chlorpromazine, pimozide, zuclopenthixol, fluphenazine, and perphenazine). The sum of antipsychotics taken was calculated for each patient. The chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose [39 (link)], and the doses of benzodiazepines were calculated using the equivalent benzodiazepine calculator based on the valium equivalence [40 ].
Mood stabilizers comprised lithium carbonate and antiepileptic medications (valproic acid, carbamazepine, pregabalin, topiramate, and phenytoin). The benzodiazepines included lorazepam, clonazepam, alprazolam, diazepam, alprazolam, and bromazepam. Anticholinergics consisted of trihexyphenidyl. Antidepressants were divided into two groups, i.e., tricyclic antidepressants (TCA, including amitriptyline, clomipramine, and imipramine) and other antidepressants (venlafaxine, sertraline).
The total anticholinergic burden was calculated based on the updated version of the Anticholinergic Drug Scale (ADS), where each medication was assigned a numerical value from 0 to 3, depending on their anticholinergic strength, and the overall ADS score for a patient was calculated by summing the values of all scheduled medications used by each participant [28 (link)]. This scale is the most comprehensive currently available for quantifying the anticholinergic burden for most medicines used to treat psychotic symptoms [28 (link)].
Serum anticholinergic activity (SAA) is considered the current gold standard in quantifying anticholinergic burden [28 (link)]. However, it is only quantified in a small number of research laboratories. An ADS scale might help determine who is the most at risk for adverse side effects and offer guidance in interventions [28 (link)]. Previous studies have shown that the ADS score was significantly associated with SAA, suggesting it is a helpful tool for assessing anticholinergic burden [28 (link), 38 (link)]. However, using ADS ratings to classify medications is a method of limited accuracy since there will be variations in anticholinergic potencies across medications within each group, regardless of the accuracy of the classification. Also, SAA might be influenced by endogenous substances, which are not measurable by the ADS scale, which only evaluates anticholinergic characteristics of medications.
Furthermore, antipsychotic medications were divided into second-generation antipsychotics or SGA (risperidone, clozapine, olanzapine, quetiapine, and paliperidone) and first-generation antipsychotics or FGA (haloperidol, chlorpromazine, pimozide, zuclopenthixol, fluphenazine, and perphenazine). The sum of antipsychotics taken was calculated for each patient. The chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose [39 (link)], and the doses of benzodiazepines were calculated using the equivalent benzodiazepine calculator based on the valium equivalence [40 ].
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