Reducing Anticholinergic Medication Burden in Patients With Psychotic or Bipolar Disorders

J Clin Psychiatry. Nov/Dec 2017;78(9):e1270-e1275. doi: 10.4088/JCP.16m11269.


Objective: Anticholinergic medications are prescribed to treat extrapyramidal side effects (EPS) associated with antipsychotics. Anticholinergic medications cause several side effects and can often be withdrawn during the maintenance phase of antipsychotic treatment without EPS reemergence. The purpose of this quality improvement (QI) project was to reduce anticholinergic medication burden and improve quality of life in patients with severe mental illness.

Methods: Patients with DSM-IV-TR-diagnosed schizophrenia, schizoaffective disorder, and bipolar disorders in an outpatient psychiatric clinic who were prescribed benztropine were identified, screened for anticholinergic side effects by the treating psychiatrist, and referred to an on-site clinical pharmacist for a comprehensive medication review. Anticholinergic side effects, cognitive impairment, and impact on quality of life were assessed using a Likert scale. Recommendations for potential medication changes were discussed with the prescriber. Initial and follow-up assessments were conducted over 1-8 months to identify improvements in side effects and quality of life.

Results: Twenty-nine patients were assessed from November 2014 to December 2015. Patients were receiving from 1 to 6 medications with anticholinergic properties (median = 3 medications). Of the 29 patients, 19 were recommended for a medication change, with 13 having 1 or more anticholinergic medications discontinued and 6 having the dose decreased. A significant reduction in anticholinergic side effects and improvements in memory and quality of life were observed for these patients (P ≤ .05).

Conclusions: In this interdisciplinary, collaborative QI project, patients whose anticholinergic burden was reduced experienced a significant improvement in side effects, memory, and quality of life.

MeSH terms

  • Adult
  • Aged
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Basal Ganglia Diseases / drug therapy*
  • Basal Ganglia Diseases / epidemiology
  • Bipolar Disorder / drug therapy*
  • Cholinergic Antagonists / therapeutic use*
  • Cost of Illness
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Psychotic Disorders / drug therapy*
  • Quality Improvement
  • Quality of Life


  • Antipsychotic Agents
  • Cholinergic Antagonists