Anticholinergic Burden in People with Intellectual Disability in Psychiatric Inpatient Units: Practice and Audit Recommendations

Introduction: Anticholinergic burden (ACB) is the cumulative
effect of taking multiple medications with anticholinergic properties. ACB is associated with polypharmacy, increased comorbidity, and premature mortality in people with intellectual
disability (PwID). No clinical standards for ACB monitoring specific to PwID exist, particularly in psychiatric inpatient units
where the risk of ACB is highest.
Method: We used the ACB Calculator and Anticholinergic Effect
on Cognition (AEC) scale to compute ACB scores in two English
psychiatric units. We administered the Liverpool University Side
Effect Rating Scale (LUNSERS) and Glasgow Antipsychotic Side
Effect Scale (GASS) to examine patients’ perception of sideeffects.
Results: Of 19 patients, the ACB Calculator mean was 6.68 and
AEC 4.21. The LUNSERS mean was 22.72 (low side-effects) and
GASS 9.12 (absent/mild side-effects). Two prescriber groups and
two multidisciplinary sessions discussed the findings.
Conclusions: Based on our findings, practice/audit recommendations to minimize ACB for PwID in psychiatric inpatients are
suggested.