Effects of discontinuing anticholinergic treatment on movement disorders, cognition and psychopathology in patients with schizophrenia
Effects of discontinuing anticholinergic treatment on movement disorders, cognition and psychopathology in patients with schizophrenia
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DOI：
10.1177/2045125314553611
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发表时间：
2014-12-01
影响因子：
4.2
通讯作者：
Margolese, Howard C.
中科院分区：
文献类型：
--
作者：
Desmarais, Julie Eve;Beauclair, Linda;Margolese, Howard C.
背景资料：几十年来，医生一直使用抗胆碱能药物如苯托品、丙环利定、比哌立登和苯海索治疗和预防抗精神病药引起的锥体外系症状（EPS）。然而，抗胆碱能药物可加重迟发性运动障碍并引起许多不良反应，包括认知障碍。既往关于接受抗精神病药物治疗的精神分裂症患者停用抗胆碱能药物的研究得出了广泛的EPS复发率。在抗胆碱能药物停药后认知的改善被观察到在一些study.Objective：本研究评估了抗胆碱能药物停药对运动障碍，认知和一般精神病理学的影响后，4周的锥度在20例门诊精神分裂症或情感性精神障碍与抗精神病药物治疗。重复测量方差分析未显示抗胆碱能药物停药对锥体外系症状评定量表总分或帕金森综合征、静坐不能、肌张力障碍或迟发性运动障碍子量表的显著影响。然而，与基线相比，在第6、8和12周的精神分裂症综合z评分中发现了显著改善。在运动和符号编码任务上有显著的改善。阳性和阴性症状量表，临床总体印象的严重程度和临床总体印象-改善scales.Conclusion：在这12周的研究中，抗胆碱能药物停药在20例门诊精神分裂症或情感性精神障碍，逐渐减少和停药的抗胆碱能药物导致认知的积极影响。对一般精神病理学没有不良后果，20名受试者中有18名在运动障碍方面没有显著差异。
Background: Physicians have prescribed anticholinergic agents such as benztropine, procyclidine, biperiden and trihexyphenidyl for treatment and prophylaxis of antipsychoticinduced extrapyramidal symptoms (EPS) for decades. Anticholinergic agents can however worsen tardive dyskinesia and cause many adverse effects, including cognitive impairment. Previous studies of anticholinergic discontinuation in patients with schizophrenia receiving antipsychotics have yielded a wide range of EPS relapse rates. Improvement in cognition after anticholinergic withdrawal was observed in some studies.Objective: This study evaluated the effect of anticholinergic discontinuation on movement disorders, cognition and general psychopathology after a 4- week taper in 20 outpatients with schizophrenia or schizoaffective disorder treated with antipsychotics.Results: Eighteen of twenty patients successfully discontinued their anticholinergic medication; two did not because of akathisia. Repeated measures analysis of variance did not show a significant effect of anticholinergic discontinuation on total Extrapyramidal Symptoms Rating Scale score or on the Parkinsonism, Akathisia, Dystonia or Tardive Dyskinesia subscales. However, significant improvement was found on the Brief Assessment of Cognition in Schizophrenia composite z score at weeks 6, 8 and 12 compared with baseline. Significant improvements were seen on the motor and the symbol-coding tasks. No significant effects were observed on the Positive and Negative Syndrome Scale, Clinical Global Impression Severity and Clinical Global Impression - Improvement scales.Conclusion: In this 12-week study of anticholinergic discontinuation in 20 outpatients with schizophrenia or schizoaffective disorder, gradual decrease and discontinuation of anticholinergics led to a positive effect on cognition. There were no adverse consequences on general psychopathology and no significant differences for 18 of 20 subjects on movement disorders.