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Is cognitive impairment associated with antipsychotic dose and anticholinergic equivalent loads in first-episode psychosis?

Published online by Cambridge University Press:  14 January 2018

Alejandro Ballesteros ,
Ana M. Sánchez-Torres ,
Jose M. López-Ilundain ,
Bibiana Cabrera ,
Antonio Lobo ,
Ana M. González-Pinto ,
Covadonga Díaz-Caneja ,
Iluminada Corripio ,
Eduard Vieta  and
Elena de la Serna
...Show all authors
Alejandro Ballesteros
Affiliation:
Estella Mental Health Center, Dirección de Salud Mental, Pamplona, Navarra, Spain IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
Ana M. Sánchez-Torres
Affiliation:
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain
Jose M. López-Ilundain
Affiliation:
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain
Bibiana Cabrera
Affiliation:
Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
Antonio Lobo
Affiliation:
Department of Medicine and Psychiatry, University of Zaragoza. Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
Ana M. González-Pinto
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain BIOARABA Health Research Institute, OSI Araba. University Hospital, Vitoria, Spain University of the Basque Country, Vitoria, Spain
Covadonga Díaz-Caneja
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
Iluminada Corripio
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
Eduard Vieta
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences, Hospital Clinic of Barcelona, Catalonia, Spain August Pi i Sunyer Institute for Biomedical Research (IDIBAPS), Barcelona, Catalonia, Spain Department of Psychiatry and Clinical Psychology, University of Barcelona, Catalonia, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain
Elena de la Serna
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Child and Adolescent Psychiatry and Psychology Department, Department of Medicine, 2014SGR489, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
Julio Bobes
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Psychiatry Department, University of Oviedo, Oviedo, Spain Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
Judith Usall
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat Barcelona, Spain
Fernando Contreras
Affiliation:
Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Psychiatry Department, Bellvitge University Hospital-IDIBELL Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
Ruth Lorente-Omeñaca
Affiliation:
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain
Gisela Mezquida
Affiliation:
Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
Miguel Bernardo
Affiliation:
Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain Department of Psychiatry and Clinical Psychobiology, University of Barcelona, IDIBAPS, Barcelona, Spain
Manuel J. Cuesta*
Affiliation:
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain Department of Psychiatry, Complejo Hospitalario of Navarra, Pamplona, Spain
PEPs Group
Affiliation:
Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, Barcelona, Spain Network Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain BIOARABA Health Research Institute, OSI Araba. University Hospital, Vitoria, Spain University of the Basque Country, Vitoria, Spain Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain Department of Psychiatry, Hospital Clínico Universitario, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain Quiron Hospital, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain First Episode Psychiatric Unit, Valencia Clinic Hospital, INCLIVA, Valencia, Spain Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain Department of Neurosciences, University of the Basque Country (UPV/EHU), BioCruces Health Research Institute, Baracaldo, Spain Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain Sant Joan de Déu Research Foundation, Esplugues de Llobregat, Barcelona, Spain Faculty of Psychology, University of Barcelona, Spain Hospital Sant Joan de Déu, Barcelona, Spain FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain Neuroscience Research Australia, Sydney, NSW, Australia Australia School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia Australia ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain Service of Psychiatry, La Fe University and Polytechnic Hospital, Valencia, Spain Department of Medicine, University of Valencia, Valencia, Spain
*
Author for correspondence: Manuel J. Cuesta, E-mail: [email protected]
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Abstract

Background

Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.

Methods

Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].

Results

Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.

Conclusions

Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.

Keywords

Anticholinergicantipsychoticscognitionfirst episode psychosispremorbid intellectual quotient.
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 13 , October 2018 , pp. 2247 - 2256
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

†

The authors of the PEPs Group who participated in this manuscript are: Miquel Bioque4,5, Silvia Amoretti4,5, Mara Parellada5,9, Raquel Vicente5,21, Anna Alonso5,10, Mireia Rabella5,10, Itxaso González-Ortega5,7,8, Patricia Vega5,7,8, Julio Arbej22, Nicolás Fayed23, Julio Sanjuan5,24, Esther Lorente-Rovira5,24, Daniel Bergé5,25, Antoni Bulbena5,25, Diego Hidalgo-Mazzei5,11,12,13, Marina Garriga5,11,12,13, Immaculada Baeza5,15, Josefina Castro-Fornieles5,15, Àuria Albacete5,19,20, Jose Manuel Menchón5,19,20, Mª Paz García-Portilla5,16,17, Leticia García-Álvarez5,16,17, Miguel Gutiérrrez5,7, Aranzazu Zabala5,26, Roberto Rodriguez-Jimenez5,27, Isabel Morales-Muñoz27, Anna Butjosa5,18,28,29, Marta Pardo-Gallego30, Salvador Sarró5,31, Ramón Landín-Moreno32,33,34, Ángela Ibáñez5,35, Lucía Moreno-Izco2,3 and Vicente Balanzá-Martínez5,36,37.

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