Question: In adults with psychosis already taking anti-psychotic medication, how effective are cholinesterase inhibitors, compared to treatment as usual, in improving cognitive function?” Additionally, “Are the risks of cardiac side effects found to outweigh the benefits of CEIs due to parasympathetic activity and risk of exacerbating heart block, or is this not documented as a problem?

Answer:

No definite clinical implications can be made from the available evidence. Data from one wellconducted systematic review included 17 studies, but the authors stated the majority of these studies were of short-term duration (i.e. up to 12 weeks) and were of poor methodological quality. Due to the lack of good quality studies, the authors stated that the evidence was not good enough for recommending acetylcholinesterase inhibitors routinely as an add-on intervention along with antipsychotics. They did suggest, however, that the combined treatment could be tried when all other interventions have failed, but withdrawn when no clinical benefit is observed. The authors also stated that more high-quality, long-term studies are needed.