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2 results

  • Anticholinergic burden in schizophrenia and ability to benefit from psychosocial treatment programmes: a 3-year prospective cohort study

  • K. O'Reilly, P. O'Connell, G. Donohoe, C. Coyle, D. O'Sullivan, Z. Azvee, C. Maddock, K. Sharma, H. Sadi, M. McMahon, H. G. Kennedy
  • Journal:
    Psychological Medicine / Volume 46 / Issue 15 / November 2016
    Published online by Cambridge University Press:
    31 August 2016, pp. 3199-3211
  • Background

    Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychosocial treatments is unknown.

    Method

    Seventy patients were followed for approximately 3 years. The MATRICS consensus cognitive battery (MCCB) was administered at baseline. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. Ability to benefit from psychosocial programmes was measured using the DUNDRUM-3 Programme Completion Scale (D-3) at baseline and follow-up. Psychiatric symptoms were measured using the PANSS. Total antipsychotic dose was measured using chlorpromazine equivalents. Functioning was measured using the Social and Occupational Functioning Assessment Scale (SOFAS).

    Results

    Mediation analysis found that the influence of anticholinergic burden on ability to participate and benefit from psychosocial programmes was completely mediated by the MCCB. For every 1-unit increase on the ACB scale, change scores for DUNDRUM-3 decreased by −0.27 points. This relationship appears specific to anticholinergic burden and not total antipsychotic dose. Moreover, mediation appears to be specific to cognition and not psychopathology. Baseline functioning also acted as mediator but only when MCCB was not controlled for.

    Conclusions

    Anticholinergic burden has a significant impact on patients’ ability to participate in and benefit from psychosocial treatment programmes. Physicians need to be mindful of the cumulative effect that medications can have on patient cognition, functional capacity and ability to benefit from psychosocial treatments.

  • 8 - Post-traumatic stress disorder

  • Edited by Stefan Hofmann, Boston University, Mark Reinecke, Northwestern University, Illinois
  • Book:
    Cognitive-behavioral Therapy with Adults
    Published online:
    10 November 2010
    Print publication:
    28 October 2010, pp 107-120

  • Summary

    Bipolar disorder is characterized by the occurrence of one or more manic, hypomanic, or mixed episodes and is typified by periods of mood instability. Pharmacologic treatment of bipolar disorder is associated with significant problems of medication adherence. Cognitive-behavioral therapy is an effective and empirically supported psychosocial treatment for bipolar disorder. Key elements of the CBT intervention include psychoeducation, training in medication adherence, stress management, and cognitive restructuring. In addition to CBT, several other psychosocial treatments have been applied to bipolar disorder. Group treatment has been used for bipolar disorder as a potentially cost-effective method to prevent recurrence. High rates of comorbidity exist among patients with bipolar disorder. At the present time, the evidence for the efficacy of psychosocial interventions for bipolar disorder has never been stronger. The efficacy of psychosocial treatment on specific symptom areas, prominently including the role of anger and anxiety management, needs to be investigated.