Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist–physician collaboration in the outpatient department

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Abstract

Introduction

Cognitive impairment is a core feature and shows the highest impact on functional outcome in patients with schizophrenia. There have been no previous studies investigating the role of the pharmacist in a multidisciplinary team on cognitive outcomes in patients with schizophrenia.

Purpose

We evaluated the impact of pharmacist intervention on cognitive outcomes in patients with schizophrenia by focusing on anticholinergic discontinuation.

Patients and methods

A prospective, open-label, randomized, controlled study was conducted. Patients with schizophrenia were randomly assigned to either the pharmacist intervention or usual care groups. In the pharmacist intervention group, the pharmacist identified drug-related problems (DRPs) and provided a pharmacotherapy suggestion, while there was no intervention in the usual care group. The primary outcome was mean change from baseline of executive function by using Wisconsin Card Sorting Test (WCST) perseverative errors within the pharmacist intervention group at week 12.

Results

A total of 30 patients completed the study (13 in the pharmacist intervention group and 17 in the usual care group). WCST perseverative errors at the end of the study within the pharmacist intervention group improved significantly from baseline ( P=0.003). DRPs at week 12 were reduced by 85.19% and 9.76% in the pharmacist intervention and usual care groups, respectively. The most common intervention was the discontinuation of anticholinergics in patients without extrapyramidal side effects.

Conclusion

Added-on pharmacist intervention in a multidisciplinary team could help to improve cognitive functions in patients with schizophrenia by reducing DRPs and optimizing the drug therapy regimen, especially for anticholinergic discontinuation.

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Most cited references 40

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Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS.

Michael Green, Robert Kern, Robert K. Heaton (2004)

It is generally accepted that cognitive deficits in schizophrenia are related to functional outcome. However, support for longitudinal relationships between cognition and functional outcome has not been as well documented. The current paper presents a review of 18 recently published longitudinal studies (minimum 6-month follow up) of the relationships between cognition and community outcome in schizophrenia. Results from these studies reveal considerable support for longitudinal associations between cognition and community outcome in schizophrenia. These studies demonstrate that cognitive assessment predict later functional outcome and provide a rationale for psychopharmacological interventions for cognitive deficits in schizophrenia. Although the relationships between cognition and community outcome are well-supported, it is clear that community functioning is also affected by a host of factors apart from cognition that are usually not considered in clinical trial studies (e.g., psychosocial rehabilitation and educational/vocational opportunities). In the second part of the paper, we consider intervening steps between cognitive performance measures and community outcome. These steps are apt to have important implications for clinical trials of cognition-enhancing agents in schizophrenia.

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Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?

Jonathan L Braff, Jim Mintz, M. Green … (1999)

There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships.

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Antipsychotic drug effects on brain morphology in first-episode psychosis.

Kinikanwo Green, G D Tollefson, Trevor C. Charles … (2005)

Pathomorphologic brain changes occurring as early as first-episode schizophrenia have been extensively described. Longitudinal studies have demonstrated that these changes may be progressive and associated with clinical outcome. This raises the possibility that antipsychotics might alter such pathomorphologic progression in early-stage schizophrenia. To test a priori hypotheses that olanzapine-treated patients have less change over time in whole brain gray matter volumes and lateral ventricle volumes than haloperidol-treated patients and that gray matter and lateral ventricle volume changes are associated with changes in psychopathology and neurocognition. Longitudinal, randomized, controlled, multisite, double-blind study. Patients treated and followed up for up to 104 weeks. Neurocognitive and magnetic resonance imaging (MRI) assessments performed at weeks 0 (baseline), 12, 24, 52, and 104. Mixed-models analyses with time-dependent covariates evaluated treatment effects on MRI end points and explored relationships between MRI, psychopathologic, and neurocognitive outcomes. Fourteen academic medical centers (United States, 11; Canada, 1; Netherlands, 1; England, 1). Patients with first-episode psychosis (DSM-IV) and healthy volunteers. Random allocation to a conventional antipsychotic, haloperidol (2-20 mg/d), or an atypical antipsychotic, olanzapine (5-20 mg/d). Brain volume changes assessed by MRI. Of 263 randomized patients, 161 had baseline and at least 1 postbaseline MRI evaluation. Haloperidol-treated patients exhibited significant decreases in gray matter volume, whereas olanzapine-treated patients did not. A matched sample of healthy volunteers (n = 58) examined contemporaneously showed no change in gray matter volume. Patients with first-episode psychosis exhibited a significant between-treatment difference in MRI volume changes. Haloperidol was associated with significant reductions in gray matter volume, whereas olanzapine was not. Post hoc analyses suggested that treatment effects on brain volume and psychopathology of schizophrenia may be associated. The differential treatment effects on brain morphology could be due to haloperidol-associated toxicity or greater therapeutic effects of olanzapine.

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Author and article information

Journal

Journal ID (nlm-ta): Integr Pharm Res Pract

Journal ID (iso-abbrev): Integr Pharm Res Pract

Journal ID (publisher-id): Integrated Pharmacy Research and Practice

Title: Integrated Pharmacy Research & Practice

Publisher: Dove Medical Press

ISSN (Electronic): 2230-5254

Publication date Collection: 2018

Publication date (Electronic): 26 October 2018

Volume: 7

Pages: 161-171

Affiliations

[1 ]Faculty of Pharmacy, Siam University, Bangkok, Thailand

[2 ]Department of Psychiatry, Somdet Chaopraya Institute of Psychiatry, Bangkok, Thailand

[3 ]Department of Pharmacology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

[4 ]Department of Pharmacy, Somdet Chaophraya Institute of Psychiatry, Bangkok, Thailand

[5 ]Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand, thanarat.sua@ 123456mahidol.ac.th

Author notes

Correspondence: Thanarat Suansanae, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Road, Ratchathewi, Bangkok 10400, Thailand, Tel +66 2 644 8694, Fax +66 2 644 8694, Email thanarat.sua@ 123456mahidol.ac.th

Article

Publisher ID: iprp-7-161

DOI: 10.2147/IPRP.S176653

PMC ID: 6208936

PubMed ID: 30464898

SO-VID: a7db3bae-1017-4a23-927f-5cdac0a56bc6

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist–physician collaboration in the outpatient department

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Abstract

Introduction

Purpose

Patients and methods

Results

Conclusion

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The Physician

Most cited references 40

Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS.

Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?

Antipsychotic drug effects on brain morphology in first-episode psychosis.

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