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 side-effects.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.