Pharmacopsychiatry 2011; 44(3): 114-118
DOI: 10.1055/s-0031-1275658
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009

Y.-T. Xiang1 , 2 , C.-Y. Wang2 , T.-M. Si3 , E. H. M. Lee1 , Y.-L. He4 , G. S. Ungvari5 , H. F. K. Chiu1 , S.-Y. Yang6 , M.-Y. Chong7 , C.-H. Tan8 , E.-H. Kua8 , S. Fujii9 , K. Sim10 , K. H. Yong10 , J. K. Trivedi11 , E.-K. Chung12 , P. Udomratn13 , K.-Y. Chee14 , N. Sartorius15 , N. Shinfuku16
  • 1Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, People's Republic of China
  • 2Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China
  • 3Peking University Institute of Mental Health, Beijing, People's Republic of China
  • 4Shanghai Mental Health Center, Shanghai, People's Republic of China
  • 5The University of Notre Dame Australia, Marian Centre, Perth, Australia
  • 6Taipei City Hospital, Taipei, Taiwan, Republic of China
  • 7Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan, Republic of China
  • 8National University of Singapore, Singapore
  • 9Hyogo Institute for Traumatic Stress (HITS), Kobe, Japan
  • 10Institute of Mental Health, Buangkok View, Singapore
  • 11Department of Psychiatry, C.S.M.Medical University UP (erstwhile K.G.Medical University), Lucknow, Uttar Pradesh, India
  • 12National Seoul Hospital, Seoul, Korea
  • 13Prince of Songkla University, Songkla, Thailand
  • 14Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Malaysia
  • 15University of Geneva, Geneva, Switzerland
  • 16School of Human Sciences, Seinan Gakuin University Fukuoka, Japan
Further Information

Publication History

received 24.12.2010 revised 04.03.2011

accepted 09.03.2011

Publication Date:
13 April 2011 (online)

Abstract

Objective: The aim of this study was to survey the use of anticholinergic medication (ACM) in Asia between 2001 and 2009 and examine its demographic and clinical correlates.

Method: A total of 6 761 hospitalized schizophrenia patients in 9 Asian countries and territories were examined between 2001 and 2009. The patients’ socio-demographic and clinical characteristics and the prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.

Results: The frequency of ACM prescription decreased from 66.3% in 2001, to 52.8% in 2004 and 54.6% in 2009, with wide inter-country variations at each time period. Multiple logistic regression analysis of the whole sample showed that patients taking ACM presented with more severe positive, negative, and extrapyramidal symptoms. They were also more likely to receive first-generation and depot antipsychotics and antipsychotic polypharmacy, and less likely to receive second-generation ones.

Conclusions: The wide variation in ACM prescription across Asia suggests that a combination of clinical, social, economic and cultural factors play a role in determining the use of these drugs. Regular reviews of ACM use are desirable to reveal the discrepancy between treatment guidelines and clinical practice.

References

  • 1 Carnahan RM, Lund BC, Perry PJ. et al . Increased risk of extrapyramidal side-effect treatment associated with atypical antipsychotic polytherapy.  Acta Psychiatr Scand. 2006;  113 135-141
  • 2 Lavin MR, Rifkin A. Prophylactic antiparkinson drug use: II. Withdrawal after long-term maintenance therapy.  J Clin Pharmacol. 1991;  31 769-777
  • 3 Ungvari GS, Chiu HF, Lam LC. et al . Gradual withdrawal of long-term anticholinergic antiparkinson medication in Chinese patients with chronic schizophrenia.  J Clin Psychopharmacol. 1999;  19 141-148
  • 4 Brebion G, Bressan RA, Amador X. et al . Medications and verbal memory impairment in schizophrenia: the role of anticholinergic drugs.  Psychol Med. 2004;  34 369-374
  • 5 Minzenberg MJ, Poole JH, Benton C. et al . Association of anticholinergic load with impairment of complex attention and memory in schizophrenia.  Am J Psychiatry. 2004;  161 116-124
  • 6 Land W, Pinsky D, Salzman C. Abuse and misuse of anticholinergic medications.  Hosp Community Psychiatry. 1991;  42 580-581
  • 7 Longo VG. Behavioral and electroencephalographic effects of atropine and related compounds.  Pharmacol Rev. 1966;  18 965-996
  • 8 Tandon R, Greden JF. Cholinergic hyperactivity and negative schizophrenic symptoms. A model of cholinergic/dopaminergic interactions in schizophrenia.  Arch Gen Psychiatry. 1989;  46 745-753
  • 9 Perris C, Dimitrijevic P, Jacobsson L. et al . Tardive dyskinesia in psychiatric patients treated with neuroleptics.  Br J Psychiatry. 1979;  135 509-514
  • 10 Goff DC, Arana GW, Greenblatt DJ. et al . The effect of benztropine on haloperidol-induced dystonia, clinical efficacy and pharmacokinetics: a prospective, double-blind trial.  J Clin Psychopharmacol. 1991;  11 106-112
  • 11 Vagen R, Gotestam KG. An experimental evaluation of the euphoric properties of antiparkinson drugs on psychotic patients.  Acta Psychiatr Scand. 1986;  74 519-523
  • 12 Chiu HF, Shum PS, Lam CW. Psychotropic drug prescribing to chronic schizophrenics in a Hong Kong hospital.  Int J Soc Psychiatry. 1991;  37 187-191
  • 13 Frackiewicz EJ, Sramek JJ, Herrera JM. et al . Ethnicity and antipsychotic response.  Ann Pharmacother. 1997;  31 1360-1369
  • 14 Sim K, Su A, Fujii S. et al . Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia.  Br J Clin Pharmacol. 2004;  58 178-183
  • 15 Chong MY, Tan CH, Fujii S. et al . Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change.  Psychiatry Clin Neurosci. 2004;  58 61-67
  • 16 Shinfuku N, Tan CH. Pharmacotherapy for schizophrenic inpatients in East Asia – changes and challenges.  Int Rev Psychiatry. 2008;  20 460-468
  • 17 APA .Practice Guideline for the Treatment of Patients with Schizophrenia.. Washington, DC, American Psychiatric Press; 1997
  • 18 Kane JM, Aguglia E, Altamura AC. et al . Guidelines for depot antipsychotic treatment in schizophrenia. European Neuropsychopharmacology Consensus Conference in Siena, Italy.  Eur Neuropsychopharmacol. 1998;  8 55-66
  • 19 Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics.  J Clin Psychiatry. 2003;  64 663-667
  • 20 WHO . Collaborating Centre for Drug Statistic Methodology: Guidelines for ATC Index with DDDs.  Oslo, WHO, 2002; 
  • 21 Chong MY, Tan CH, Shinfuku N. et al . Prescribing antipsychotic drugs for inpatients with schizophrenia in Asia: Comparison of REAP-2001 and REAP-2004 studies.  Asia-Pacific Psychiatry. 2010;  2 77-84
  • 22 Chong SA, Sachdev P, Mahendran R. et al . Neuroleptic and anticholinergic drug use in Chinese patients with schizophrenia resident in a state psychiatric hospital in Singapore.  Aust N Z J Psychiatry. 2000;  34 988-991
  • 23 Wu RW. The combination of antipsychotics and anticholinergic medication.  Chin Clin Doct. 2001;  29 33-34
  • 24 Lin KM, Finder E. Neuroleptic dosage for Asians.  Am J Psychiatry. 1983;  140 490-491
  • 25 Zhang-Wong J, Beiser M, Zipursky RB. et al . An investigation of ethnic and gender differences in the pharmacodynamics of haloperidol.  Psychiatry Res. 1998;  81 333-339
  • 26 Binder RL, Kazamatsuri H, Nishimura T. et al . Tardive dyskinesia and neuroleptic-induced parkinsonism in Japan.  Am J Psychiatry. 1987;  144 1494-1496
  • 27 Gray R, Gournay K. What can we do about acute extrapyramidal symptoms?.  J Psychiatr Ment Health Nurs. 2000;  7 205-211
  • 28 Phillips MR, Lu SH, Wang RW. Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience.  Am J Psychiatry. 1997;  154 1228-1234
  • 29 Double DB, Warren GC, Evans M. et al . Efficacy of maintenance use of anticholinergic agents.  Acta Psychiatr Scand. 1993;  88 381-384
  • 30 Kane JM, Evans DL, Fiester SJ. et al . Psychopharmacological screening criteria. APA Committee on Research on Psychiatric Treatments.  J Clin Psychiatry. 1992;  53 184-196
  • 31 NICE .Schizophrenia. Full National Clinical Guideline on Core Intervention in Primary and Secondary Care.. Trowbridge, Wiltshire, UK. (also: http://www.nice.org.uk/guidance/CG1/guidance/pdf/English) Cromwell Press; 2003
  • 32 WHO . Prophylactic use of anticholinergics in patients on long-term neuroleptic treatment. A consensus statement. World Health Organization heads of centres collaborating in WHO co-ordinated studies on biological aspects of mental illness.  Br J Psychiatry. 1990;  156 412
  • 33 Work Group on Schizophrenia .Practice Guideline for the Treatment of Patients with Schizophrenia. Second Edition.. APA Practice Guidelines. Washington, DC, American Psychiatric Press; 2004
  • 34 Sim K, Su HC, Fujii S. et al . High-dose antipsychotic use in schizophrenia: a comparison between the 2001 and 2004 Research on East Asia Psychotropic Prescription (REAP) studies.  Br J Clin Pharmacol. 2009;  67 110-117
  • 35 Xiang YT, Weng YZ, Leung CM. et al . Clinical and social determinants of antipsychotic polypharmacy for Chinese patients with schizophrenia.  Pharmacopsychiatry. 2007;  40 47-52
  • 36 Greil W, Haag H, Rossnagl G. et al . Effect of anticholinergics on tardive dyskinesia. A controlled discontinuation study.  Br J Psychiatry. 1984;  145 304-310
  • 37 Dayalu P, Chou KL. Antipsychotic-induced extrapyramidal symptoms and their management.  Expert Opin Pharmacother. 2008;  9 1451-1462
  • 38 Taylor D, Paton C, Kerwin R. The Maudsley Prescribing Guidelines.. London, Martin Dunitz; 2003
  • 39 Xiang YT, Weng YZ, Leung CM. et al . Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia.  Hum Psychopharmacol. 2007;  22 173-180
  • 40 Leucht S, Wahlbeck K, Hamann J. et al . New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis.  Lancet. 2003;  361 1581-1589

Correspondence

Dr. Y.-T. Xiang

Department of Psychiatry

Chinese University of

Hong Kong

Ground Floor, Multicentre

Tai Po Hospital

Tai Po, N.T.

Hong Kong

People's Republic of China

Phone: +852/2607/6041

Fax: +852/2647/5321

Email: xyutly@gmail.com

Dr. Tian-Mei Si

Peking University Institute of

Mental Health

Beijing

People's Republic of China

Phone: + 8610/8280/1948

Fax: +8610/6235/2880

Email: si.tian-mei@163.com

    >