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Kameyama H, Sugimoto K, Kodaka F, Okuno K, Masaki T, Nukariya K, Shigeta M. Association between the early repolarization pattern and nocturnal suicide attempts. Neuropsychopharmacol Rep 2024; 44:410-416. [PMID: 38494338 PMCID: PMC11144600 DOI: 10.1002/npr2.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
AIM Numerous recent reports have highlighted the association between mental disorders and electrocardiographic findings. The early repolarization pattern (ERP) on electrocardiogram has been linked with a history of suicide attempts and attention deficit hyperactivity disorder, and associations with impulsivity have also been reported. It is known that suicidal intent is more common at night. Patients who have a mental disorder and ERP may have a higher likelihood of impulsivity, potentially increasing the risk of suicide at night. METHODS The subjects were 43 patients with a history of suicide attempts who had undergone electrocardiographic examination at Jikei University School of Medicine Kashiwa Hospital and received intervention from our department. Due to the diurnal variation in electrocardiographic findings, only patients who underwent the examination during the daytime were included. Patients' clinical backgrounds were compared according to the presence or absence of ERP, and the association between nocturnal suicide attempts and ERP was examined using multivariate analysis. RESULTS The frequency of nocturnal suicidal behavior was 76.2% in patients with ERP and 31.8% in those without ERP, but the difference was not significant after Bonferroni correction. In the multivariate analysis, there was a significant association of ERP with nocturnal suicide attempts (p = 0.018). CONCLUSION The finding of an association between ERP and nocturnal suicide attempts indicates that ERP is a biological indicator that can predict nocturnal suicide attempts.
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Affiliation(s)
- Hiroshi Kameyama
- Department of PsychiatryThe Jikei University School of MedicineTokyoJapan
- Department of PsychiatryThe Jikei University Kashiwa HospitalChibaJapan
| | - Kenichi Sugimoto
- Department of Laboratory MedicineThe Jikei University School of MedicineTokyoJapan
| | - Fumitoshi Kodaka
- Department of PsychiatryThe Jikei University School of MedicineTokyoJapan
| | - Kenji Okuno
- Department of Emergency MedicineThe Jikei University Kashiwa HospitalChibaJapan
| | - Takahiro Masaki
- Department of Laboratory MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kazutaka Nukariya
- Department of PsychiatryThe Jikei University Kashiwa HospitalChibaJapan
| | - Masahiro Shigeta
- Department of PsychiatryThe Jikei University School of MedicineTokyoJapan
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2
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Baruth JM, Bateman DR, Kovacs RJ, Bateman PV, Pazdernik VM, Santivasi WL, Dunlay SM, Lapid MI. Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life. Schizophr Res 2023; 262:60-66. [PMID: 37925752 DOI: 10.1016/j.schres.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/11/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Daniel R Bateman
- Dept. of Behavioral Health, Indiana University, Indianapolis, IN, USA
| | | | | | | | - Wil L Santivasi
- Center for Palliative Care, Department of Medicine, Duke University, Durham, NC, USA
| | - Shannon M Dunlay
- Dept. of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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3
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Theisen B, Holtz A, Rajagopalan V. Noncoding RNAs and Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes in Cardiac Arrhythmic Brugada Syndrome. Cells 2023; 12:2398. [PMID: 37830612 PMCID: PMC10571919 DOI: 10.3390/cells12192398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Hundreds of thousands of people die each year as a result of sudden cardiac death, and many are due to heart rhythm disorders. One of the major causes of these arrhythmic events is Brugada syndrome, a cardiac channelopathy that results in abnormal cardiac conduction, severe life-threatening arrhythmias, and, on many occasions, death. This disorder has been associated with mutations and dysfunction of about two dozen genes; however, the majority of the patients do not have a definite cause for the diagnosis of Brugada Syndrome. The protein-coding genes represent only a very small fraction of the mammalian genome, and the majority of the noncoding regions of the genome are actively transcribed. Studies have shown that most of the loci associated with electrophysiological traits are located in noncoding regulatory regions and are expected to affect gene expression dosage and cardiac ion channel function. Noncoding RNAs serve an expanding number of regulatory and other functional roles within the cells, including but not limited to transcriptional, post-transcriptional, and epigenetic regulation. The major noncoding RNAs found in Brugada Syndrome include microRNAs; however, others such as long noncoding RNAs are also identified. They contribute to pathogenesis by interacting with ion channels and/or are detectable as clinical biomarkers. Stem cells have received significant attention in the recent past, and can be differentiated into many different cell types including those in the heart. In addition to contractile and relaxational properties, BrS-relevant electrophysiological phenotypes are also demonstrated in cardiomyocytes differentiated from stem cells induced from adult human cells. In this review, we discuss the current understanding of noncoding regions of the genome and their RNA biology in Brugada Syndrome. We also delve into the role of stem cells, especially human induced pluripotent stem cell-derived cardiac differentiated cells, in the investigation of Brugada syndrome in preclinical and clinical studies.
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Affiliation(s)
- Benjamin Theisen
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Austin Holtz
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Viswanathan Rajagopalan
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
- Arkansas Biosciences Institute, Jonesboro, AR 72401, USA
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4
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Li Y, Tang C, Wu W, Li Z, Li X, Huang W, Chen W, Mai X, Li X, Xu C, Xie G, Liang J. Abnormal blood lipid and electrocardiogram characteristics in common mental disorders. BMC Psychiatry 2023; 23:465. [PMID: 37365547 DOI: 10.1186/s12888-023-04965-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND At present, there is not enough evidence to prove the relationship between blood lipid and electrocardiogram (ECG) abnormalities in common mental disorders (CMD). This study aimed to explore the relationship between them, to detect and prevent arrhythmia or sudden death. METHODS We collected 272 CMD patients (maintained a fixed drug dose pattern for 1 year or more), including 95 schizophrenias (SC), 90 bipolar disorders (BD) and 87 major depressive disorders (MDD), and 78 healthy controls (HC) from the Third People's Hospital of Foshan, China. We analyzed and compared their blood lipid and ECG indicators, to clarify the relationship between them. RESULTS 350 participants were included. There were no significant differences in age, gender, total cholesterol (TC), low density lipoprotein (LDL) and QTc (p > 0.05) among subjects. And there were significant differences in body mass index (BMI), triglyceride (TG), high density lipoprotein (HDL), heart rate, PR interval and QRS width (p < 0.05). Person correlation analysis showed that QRS width was positively correlated with BMI and TG. And negatively correlated with HDL. Meanwhile, QTc was positively correlated with BMI. Multiple linear regional analysis further proved that TG (B = 3.849, p = 0.007) and LDL (B = 11.764, p = 0.018) were the risk factors, and HDL (B = -9.935, p = 0.025) was the protective factor for QRS width increase. CONCLUSION Long term medication of CMD patients should strengthen weight management, and conduct regular blood lipid and ECG examinations to achieve early detection and intervention in order to promote their health.
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Affiliation(s)
- Yan Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Chaohua Tang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Weibo Wu
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Zhijian Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xuesong Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Wei Huang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Wensheng Chen
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xiancong Mai
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xiaoling Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Caixia Xu
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China.
| | - Jiaquan Liang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China.
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5
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Remme CA. SCN5A channelopathy: arrhythmia, cardiomyopathy, epilepsy and beyond. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220164. [PMID: 37122208 PMCID: PMC10150216 DOI: 10.1098/rstb.2022.0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/31/2022] [Indexed: 05/02/2023] Open
Abstract
Influx of sodium ions through voltage-gated sodium channels in cardiomyocytes is essential for proper electrical conduction within the heart. Both acquired conditions associated with sodium channel dysfunction (myocardial ischaemia, heart failure) as well as inherited disorders secondary to mutations in the gene SCN5A encoding for the cardiac sodium channel Nav1.5 are associated with life-threatening arrhythmias. Research in the last decade has uncovered the complex nature of Nav1.5 distribution, function, in particular within distinct subcellular subdomains of cardiomyocytes. Nav1.5-based channels furthermore display previously unrecognized non-electrogenic actions and may impact on cardiac structural integrity, leading to cardiomyopathy. Moreover, SCN5A and Nav1.5 are expressed in cell types other than cardiomyocytes as well as various extracardiac tissues, where their functional role in, e.g. epilepsy, gastrointestinal motility, cancer and the innate immune response is increasingly investigated and recognized. This review provides an overview of these novel insights and how they deepen our mechanistic knowledge on SCN5A channelopathies and Nav1.5 (dys)function. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.
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Affiliation(s)
- Carol Ann Remme
- Department of Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
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6
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Treur JL, Thijssen AB, Smit DJ, Tadros R, Veeneman RR, Denys D, Vermeulen JM, Barc J, Bergstedt J, Pasman JA, Bezzina CR, Verweij KJH. Associations of schizophrenia with arrhythmic disorders and electrocardiogram traits: an in-depth genetic exploration of population samples. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.21.23290286. [PMID: 37292618 PMCID: PMC10246121 DOI: 10.1101/2023.05.21.23290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. While arrhythmic disorders play an important role in this, the nature of the relation between schizophrenia and arrhythmia is not fully understood. Methods We leveraged summary-level data of large-scale genome-wide association studies of schizophrenia (53,386 cases 77,258 controls), arrhythmic disorders (atrial fibrillation, 55,114 cases 482,295 controls; Brugada syndrome, 2,820 cases 10,001 controls) and electrocardiogram traits (heart rate (variability), PR interval, QT interval, JT interval, and QRS duration, n=46,952-293,051). First, we examined shared genetic liability by assessing global and local genetic correlations and conducting functional annotation. Next, we explored bidirectional causal relations between schizophrenia and arrhythmic disorders and electrocardiogram traits using Mendelian randomization. Outcomes There was no evidence for global genetic correlations, except between schizophrenia and Brugada (rg=0·14, p=4·0E-04). In contrast, strong positive and negative local genetic correlations between schizophrenia and all cardiac traits were found across the genome. In the strongest associated regions, genes related to immune system and viral response mechanisms were overrepresented. Mendelian randomization indicated a causal, increasing effect of liability to schizophrenia on Brugada syndrome (OR=1·15, p=0·009) and heart rate during activity (beta=0·25, p=0·015). Interpretation While there was little evidence for global genetic correlations, specific genomic regions and biological pathways important for both schizophrenia and arrhythmic disorders and electrocardiogram traits emerged. The putative causal effect of liability to schizophrenia on Brugada warrants increased cardiac monitoring and potentially early medical intervention in patients with schizophrenia. Funding European Research Council Starting Grant.
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Affiliation(s)
- Jorien L Treur
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Anaiïs B Thijssen
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Dirk Ja Smit
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Rada R Veeneman
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Julien Barc
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, 8 Quai Moncousu, 44007 Nantes, France
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Joëlle A Pasman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Connie R Bezzina
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Karin J H Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
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7
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Haloperidol-Induced Brugada-Pattern Electrocardiogram-A Case Report and a Review of the Literature. J Clin Psychopharmacol 2023; 43:178-180. [PMID: 36857555 DOI: 10.1097/jcp.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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8
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Attard A, Stanniland C, Attard S, Iles A, Rajappan K. Brugada syndrome: should we be screening patients before prescribing psychotropic medication? Ther Adv Psychopharmacol 2022; 12:20451253211067017. [PMID: 35111298 PMCID: PMC8801628 DOI: 10.1177/20451253211067017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Brugada syndrome (BrS) presents with a characteristic electrocardiogram (ECG) and is associated with sudden cardiac death. Until now, prolongation of QTc interval and its association with Torsade de Pointe and possible fatal arrhythmia have been the focus of routine baseline ECGs before prescribing psychotropic medication. A semi-systematic literature review was conducted using PubMed. The terms 'Brugada', 'Brugada Syndrome' AND 'psychotropic' 'antipsychotic' 'antidepressant' 'mood stabilisers' 'clozapine' 'Tricyclic Antidepressants' 'Lithium' were searched. From a search that delivered over 200 articles, 82 articles were included. Those that included details around causative medication, doses of medication and where clear timeline on drug cause were included. Where clarification was needed, the manufacturer of the medication was contacted directly. Psychotropic medication can be associated with BrS, Brugada phenocopy or unmasking of BrS, in overdose or in normal doses. Our results include a table summarising a number of psychotropic overdoses that led to BrS unmasking. Routine screening for BrS in patients before prescribing psychotropic medication is a natural extension of the baseline ECG currently routinely done to rule out QTc prolongation. Psychiatrists need to invest in ensuring better skills in interpreting ECGs and work closer with cardiologists in interpreting ECGs.
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Affiliation(s)
- Azizah Attard
- Department of Pharmacy, West London NHS Trust, Southall UB1 3EUN2 PCN, Virtually Healthcare, London
| | | | - Stephen Attard
- Central and North West London NHS Foundation Trust, London, UK
| | - Andrew Iles
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Kim Rajappan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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9
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Veeneman RR, Vermeulen JM, Abdellaoui A, Sanderson E, Wootton RE, Tadros R, Bezzina CR, Denys D, Munafò MR, Verweij KJH, Treur JL. Exploring the Relationship Between Schizophrenia and Cardiovascular Disease: A Genetic Correlation and Multivariable Mendelian Randomization Study. Schizophr Bull 2021; 48:463-473. [PMID: 34730178 PMCID: PMC8886584 DOI: 10.1093/schbul/sbab132] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with schizophrenia have a reduced life-expectancy compared to the general population, largely due to an increased risk of cardiovascular disease (CVD). Clinical and epidemiological studies have been unable to unravel the nature of this relationship. We obtained summary-data of genome-wide-association studies of schizophrenia (N = 130 644), heart failure (N = 977 323), coronary artery disease (N = 332 477), systolic and diastolic blood pressure (N = 757 601), heart rate variability (N = 46 952), QT interval (N = 103 331), early repolarization and dilated cardiomyopathy ECG patterns (N = 63 700). We computed genetic correlations and conducted bi-directional Mendelian randomization (MR) to assess causality. With multivariable MR, we investigated whether causal effects were mediated by smoking, body mass index, physical activity, lipid levels, or type 2 diabetes. Genetic correlations between schizophrenia and CVD were close to zero (-0.02-0.04). There was evidence that liability to schizophrenia causally increases heart failure risk. This effect remained consistent with multivariable MR. There was also evidence that liability to schizophrenia increases early repolarization pattern, largely mediated by BMI and lipids. Finally, there was evidence that liability to schizophrenia increases heart rate variability, a direction of effect contrasting clinical studies. There was weak evidence that higher systolic blood pressure increases schizophrenia risk. Our finding that liability to schizophrenia increases heart failure is consistent with the notion that schizophrenia involves a systemic dysregulation of the body with detrimental effects on the heart. To decrease cardiovascular mortality among individuals with schizophrenia, priority should lie with optimal treatment in early stages of psychosis.
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Affiliation(s)
- Rada R Veeneman
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jentien M Vermeulen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdel Abdellaoui
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eleanor Sanderson
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robyn E Wootton
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Nic Waals institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Connie R Bezzina
- Department of Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcus R Munafò
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Karin J H Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,To whom correspondence should be addressed; Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands; tel: +31(0)20-8913600, e-mail:
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10
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Genetic investigations of 100 inherited cardiac disease-related genes in deceased individuals with schizophrenia. Int J Legal Med 2021; 135:1395-1405. [PMID: 33973092 DOI: 10.1007/s00414-021-02595-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022]
Abstract
Cardiac diseases and sudden cardiac death (SCD) are more prevalent in individuals diagnosed with schizophrenia compared to the general population, with especially coronary artery disease (CAD) as the major cardiovascular cause of death. Antipsychotic medications, genetics, and lifestyle factors may contribute to the increased SCD in individuals with schizophrenia. The role of antipsychotic medications and lifestyle factors have been widely investigated, while the genetic predisposition to inherited cardiac diseases in schizophrenia is poorly understood. In this study, we examined 100 genes associated with inherited cardiomyopathies and cardiac channelopathies in 97 deceased individuals diagnosed with schizophrenia for the prevalence of genetic variants associated with SCD. The deceased individuals had various causes of death and were included in the SURVIVE project, a prospective, autopsy-based study of mentally ill individuals in Denmark. This is the first study of multiple inherited cardiac disease-related genes in deceased individuals with diagnosed schizophrenia to shed light on the genetic predisposition to SCD in individuals with schizophrenia. We found no evidence for an overrepresentation of rare variants with high penetrance in inherited cardiac diseases, following the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG) consensus guidelines. However, we found that the deceased individuals had a statistically significantly increased polygenic burden caused by variants in the investigated heart genes compared to the general population. This indicates that common variants with smaller effects in heart genes may play a role in schizophrenia.
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11
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Vohra J. Sudden Cardiac Death in Schizophrenia: A Review. Heart Lung Circ 2020; 29:1427-1432. [DOI: 10.1016/j.hlc.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
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12
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Kaur P, Bendaram SR, Singh B, Elkattawy S, Sah A, Noori M, Pullatt R, Shamoon F. A STEMI mimic (Brugada ECG pattern) unveiled by influenza fever. J Community Hosp Intern Med Perspect 2020; 10:488-490. [PMID: 33235689 PMCID: PMC7671723 DOI: 10.1080/20009666.2020.1797286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Brugada syndrome is a genetic disease with a characteristic electrocardiogram (ECG) findings of ST elevation in leads V1-V3 with a right bundle branch block (RBBB) appearance called Brugada ECG pattern and a tendency to develop malignant polymorphic ventricular arrhythmias that may lead to syncope or cardiac arrest. Common triggers for Brugada ECG pattern include fever, tricyclic antidepressants, lithium, cocaine and alcohol. This ECG pattern together with clinical findings mentioned above is termed Brugada Syndrome. We report a case of a 51-year-old male with a past medical history of hypertension presented to emergency department with 2-day complaint of fever, chills, sore throat, nasal congestion, malaise, productive cough, was positive for Influenza B and on ECG found to have type-I (coved) Brugada ECG pattern. Influenza fever associated with Brugada ECG pattern is a rare manifestation; in fact, to the best of our knowledge, only three case reports have been published in the literature to date.
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Affiliation(s)
- Parminder Kaur
- Internal Medicine , Saint Joseph's University Medical Center Paterson, New Jersey, USA
| | | | - Balraj Singh
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Sherif Elkattawy
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Anuraag Sah
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Muhammad Noori
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Raja Pullatt
- Internal Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Fayez Shamoon
- Internal Medicine , Saint Joseph's University Medical Center Paterson, New Jersey, USA
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13
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Fitzgerald JL, Hay K, Sheridan J, Chadwick A, Burke A, Haqqani HM. Late Potentials and Early Repolarisation Are Associated With Serious Mental Illness and May Portend Increased Arrhythmic Risk. Heart Lung Circ 2020; 29:1476-1483. [PMID: 32327309 DOI: 10.1016/j.hlc.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with serious mental illness (SMI) have an increased risk of sudden death. Higher rates of signal-averaged electrocardiogram (SAECG) abnormal late potentials (LP), which may be a predictor of sudden death risk, have been shown in patients with schizophrenia. We aimed to assess the prevalence and predictors of electrocardiograph (ECG) and SAECG abnormalities in a mixed SMI population. METHODS Consecutive consenting inpatients with SMI had 12-lead ECG and SAECG recorded in addition to demographics, diagnoses and medications. Standard criteria for abnormal SAECG were applied. Multivariate regression analysis was performed to determine predictors of SAECG abnormalities including diagnoses, body mass index, ECG parameters, psychotropic medication use, and medications associated with Long QT or Brugada syndromes. RESULTS Eighty (80) patients, 49% male, mean age 39±17 years were included. SAECG criteria abnormality for 1, 2 or 3 criteria were seen in 19, 3 and 5 cases (34% in total) respectively. Early repolarisation pattern was seen in 19% of patients. SAECG abnormality was associated with male gender (OR 7.3; 95% CI 2.3-23.4), and schizophrenia/schizoaffective disorder diagnosis (OR 7.4; 95% CI 1.9-29.0), but not with medication type or dose. CONCLUSIONS In the mixed SMI population studied, there was a high rate of SAECG-detected late potentials (34%) and early repolarisation pattern (19%). Schizophrenia/schizoaffective disorder diagnosis was the strongest multivariate predictor identified. Further studies are needed to define the mechanism and significance of these cardiac abnormalities in SMI patients.
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Affiliation(s)
- John L Fitzgerald
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia
| | - Judith Sheridan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Alex Chadwick
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Andrew Burke
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
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14
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Rastogi A, Viani-Walsh D, Akbari S, Gall N, Gaughran F, Lally J. Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review. Gen Hosp Psychiatry 2020; 67:83-91. [PMID: 33065406 PMCID: PMC7537626 DOI: 10.1016/j.genhosppsych.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls. METHODS We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD. FINDINGS Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation. CONCLUSIONS AND FUTURE DIRECTIONS Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.
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Affiliation(s)
- Anuj Rastogi
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.
| | - Dylan Viani-Walsh
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.
| | - Shareef Akbari
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.
| | - Nicholas Gall
- Department of Cardiology, King's College Hospital NHS Foundation Trust, United Kingdom.
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King's College London, United Kingdom.
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King's College London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; St Vincent's Hospital Fairview, Dublin, Ireland; Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland.
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15
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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16
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Sutterland AL, Blom MT, Ladee K, Lubbers JJM, Cohen D, de Haan L, Tan HL. Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders. Schizophr Res 2019; 210:59-65. [PMID: 31248748 DOI: 10.1016/j.schres.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to prolonged QTc interval and increased prevalence of cardiovascular risk factors. However, defective ion channels implicated in both schizophrenia and Brugada Syndrome (BrS) may be associated with an increased risk of cardiac arrhythmias. Moreover, these cardiac arrhythmias can be provoked by various drugs, including psychotropic drugs. OBJECTIVE To assess the prevalence of the occurrence of ECG suspicious for BrS (suspect BrS-ECG) and the prevalence of BrS in patients with recent onset schizophrenia spectrum disorders (SSD). METHODS In this case-control study, ECGs of 388 patients with recent onset SSD admitted between 2006 and 2015 and 844 healthy controls were made. All persons who had a suspect BrS-ECG were offered an ajmaline provocation test to diagnose or exclude BrS. Data on possible confounders were ascertained. Patients with and without suspect BrS-ECG were compared regarding clinical and ECG variables. RESULTS Suspect BrS-ECG was found in 33 patients (8.5%) and 13 healthy controls (1.5%), with an adjusted Odds Ratio of 3.5 (p < 0.0001). This finding was not explained by potential confounders such as gender, age, ethnicity, cannabis use, cardiovascular risk factors, medication use or serum electrolytes. BrS was confirmed in three patients and one control. CONCLUSION A considerable subset of patients with recent onset SSD have suspect BrS-ECG, extending earlier findings in patients with chronic schizophrenia. Screening for BrS in schizophrenia could be relevant both to prevent sudden cardiac death and to identify a subgroup of patients with possible ion-channel dysfunctioning.
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Affiliation(s)
- Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Amsterdam, the Netherlands.
| | - Marieke T Blom
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands
| | - Katinka Ladee
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Amsterdam, the Netherlands
| | - Jorieke J M Lubbers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Amsterdam, the Netherlands
| | - Dan Cohen
- Mental Health Service North-Holland North, Department of Community Mental Health, Heerhugowaard, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands
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17
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Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2018; 6:173-179. [PMID: 30533520 PMCID: PMC6282764 DOI: 10.12691/ajmcr-6-9-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Brugada syndrome is a rare cardiac arrhythmia which is associated with right bundle branch block pattern (RBBB) and ST-segment elevation in right precordial leads. SCNA5 mutation is the most common genetic abnormality associated with Brugada syndrome. Brugada pattern not related to genetic mutations has been previously reported in the setting of fever, metabolic conditions, lithium use, marijuana and cocaine abuse, ischemia and pulmonary embolism, myocardial and pericardial diseases. Multiple isolated cases of Brugada pattern associated with diabetic ketoacidosis (DKA) have been previously reported. We here present a case of type 1 Brugada pattern in a 23 year-old-male who presented with DKA. Brugada pattern in DKA is attributed to acidosis and multiple electrolyte abnormalities including hyperkalemia which alter ion channel expression in the heart thus leading to Brugada pattern which subsequently resolved with treatment of DKA. In such patients, Brugada pattern is not reproducible on procainamide induction cardiac electrophysiology study (EPS). Our scoping study demonstrates male predominance 20/22 cases of (DELETE this highlighted area) Brugada pattern in DKA, a finding that is consistent with prevalence of this disease among males.
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18
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Affiliation(s)
- Hideki Itoh
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
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19
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Sawyer M, Goodison G, Smith L, Peereboom V, Dauber K, Siskind D. Brugada pattern associated with clozapine initiation in a man with schizophrenia. Intern Med J 2017; 47:831-833. [PMID: 28677308 DOI: 10.1111/imj.13477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/27/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Sawyer
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Geraldine Goodison
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lesley Smith
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Veta Peereboom
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kieran Dauber
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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20
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Solmi M, Murru A, Pacchiarotti I, Undurraga J, Veronese N, Fornaro M, Stubbs B, Monaco F, Vieta E, Seeman MV, Correll CU, Carvalho AF. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review. Ther Clin Risk Manag 2017; 13:757-777. [PMID: 28721057 PMCID: PMC5499790 DOI: 10.2147/tcrm.s117321] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Since the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients - psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the "behavioral toxicity" conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis.
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Affiliation(s)
- Marco Solmi
- Neuroscience Department, University of Padua
- Institute for Clinical Research and Education in Medicine, Padua, Italy
| | - Andrea Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Juan Undurraga
- Department of Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo
- Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile
| | - Nicola Veronese
- Institute for Clinical Research and Education in Medicine, Padua, Italy
- National Research Council, Ageing Section, Padua
| | - Michele Fornaro
- Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, School of Medicine, University “Federico II”, Naples, Italy
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Brendon Stubbs
- Institute for Clinical Research and Education in Medicine, Padua, Italy
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Francesco Monaco
- Institute for Clinical Research and Education in Medicine, Padua, Italy
| | - Eduard Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Christoph U Correll
- Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks
- Department of Psychiatry and Molecular Medicine Hempstead, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - André F Carvalho
- Institute for Clinical Research and Education in Medicine, Padua, Italy
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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21
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Ota H, Kawamura Y, Sato N, Hasebe N. A Carbamazepine-induced Brugada-type Electrocardiographic Pattern in a Patient with Schizophrenia. Intern Med 2017; 56:3047-3050. [PMID: 29142189 PMCID: PMC5725859 DOI: 10.2169/internalmedicine.8875-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 61-year-old man with schizophrenia who was treated with carbamazepine, in whom electrocardiography showed transient Brugada-type ST elevation. He had been hospitalized our hospital's Department of Psychiatry and had been diagnosed with pneumonia. On the following day, electrocardiography showed coved-type ST elevation in the right precordial leads and a blood examination revealed that the patient's carbamazepine concentration was at the upper limit of the standard range, as well as hypothyroidism. The patient's electrocardiogram normalized after the withdrawal of carbamazepine. We demonstrated that the patient's carbamazepine concentration-and not hypothyroidism-was associated with the serial electrocardiographic changes by monitoring the patient's blood concentration of carbamazepine and his thyroid function.
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Affiliation(s)
- Hisanobu Ota
- Department of Cardiology, Hakodate Watanabe Hospital, Japan
| | - Yuichiro Kawamura
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Nobuyuki Sato
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Japan
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22
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Alda JA, Muñoz-Samons D, Tor J, Merchán-Naranjo J, Tapia-Casellas C, Baeza I, Calvo-Escalona R, Castro-Fornieles J, Martínez-Cantarero C, Andrés-Nestares P, Fernández-Avilés F, Arango C. Absence of Change in Corrected QT Interval in Children and Adolescents Receiving Antipsychotic Treatment: A 12 Month Study. J Child Adolesc Psychopharmacol 2016; 26:449-57. [PMID: 26779966 DOI: 10.1089/cap.2015.0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prescriptions of antipsychotic drugs (AP) in children and adolescents have significantly increased in Europe as well as in the United States. However, there is limited evidence of the cardiac safety of second-generation antipsychotics (SGA) in the pediatric population. OBJECTIVE The aim of the study is to evaluate the cardiac side effects of SGA in children and adolescents, and how they are influenced by clinical, demographic, and treatment factors. METHODS This article presents a naturalistic, longitudinal, multicenter study conducted in 216 treatment-naïve or quasi-naïve children and adolescents receiving AP treatment. It analyzed the possible influence of AP treatment on variables such as corrected QT (QTc) intervals and heart rate for a period of 12 months (baseline, 3 months, 6 months, and 12 months). Differences among the three main prescribed drugs used in the sample (risperidone, quetiapine, and olanzapine) were assessed. RESULTS A total of 211 received one of the three most prescribed AP (quetiapine, risperidone or olanzapine). There were no significant QTc variations in the sample during follow-up (p = 0.54). There were no differences in QTc rates between the different SGA (risperidone-olanzapine p = 0.43; risperidone-quetiapine p = 0.42; olanzapine-quetiapine p = 0.23). When demographic, clinical, or concomitant treatment variables were considered, only baseline overweight correlated with QTc prolongation (p = 0.003). The heart rate in the whole sample tended to decrease during follow-up (p = 0.054). However, patients on quetiapine showed increased heart rate compared with those on risperidone (p = 0.04). CONCLUSIONS In this sample, SGA seem to have a safe heart side effect profile in the child and adolescent population. There was no observed mean increase in QTc or in heart rate.
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Affiliation(s)
- José A Alda
- 1 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu, Barcelona , Spain
| | - Daniel Muñoz-Samons
- 1 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu, Barcelona , Spain
| | - Jordina Tor
- 1 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu, Barcelona , Spain
| | - Jessica Merchán-Naranjo
- 2 Child and Adolescent Psychiatry Department. Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense , Madrid, Spain
| | - Cecilia Tapia-Casellas
- 2 Child and Adolescent Psychiatry Department. Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense , Madrid, Spain
| | - Inmaculada Baeza
- 3 Child and Adolescent Psychiatry and Psychology, Neurosciences Institute, Hospital Clínic Universitari de Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosa Calvo-Escalona
- 3 Child and Adolescent Psychiatry and Psychology, Neurosciences Institute, Hospital Clínic Universitari de Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josefina Castro-Fornieles
- 3 Child and Adolescent Psychiatry and Psychology, Neurosciences Institute, Hospital Clínic Universitari de Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- 4 Department of Psychiatry and Clinical Psychobiology, University of Barcelona , Barcelona, Spain
| | - Carmen Martínez-Cantarero
- 5 Child and Adolescent Psychiatry and Psychology Department, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
| | - Patricia Andrés-Nestares
- 5 Child and Adolescent Psychiatry and Psychology Department, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
| | - Francisco Fernández-Avilés
- 6 Department of Cardiology. Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense , Madrid, Spain
| | - Celso Arango
- 2 Child and Adolescent Psychiatry Department. Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense , Madrid, Spain
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23
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Konigstein M, Rosso R, Topaz G, Postema PG, Friedensohn L, Heller K, Zeltser D, Belhassen B, Adler A, Viskin S. Drug-induced Brugada syndrome: Clinical characteristics and risk factors. Heart Rhythm 2016; 13:1083-1087. [DOI: 10.1016/j.hrthm.2016.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Indexed: 02/01/2023]
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24
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Sorajja D, Ramakrishna H, Poterack AK, Shen WK, Mookadam F. Brugada syndrome and its relevance in the perioperative period. Ann Card Anaesth 2016; 18:403-13. [PMID: 26139749 PMCID: PMC4881698 DOI: 10.4103/0971-9784.159812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.
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Affiliation(s)
| | | | | | | | - Farouk Mookadam
- Department of Anesthesiology, Mayo Clinic, Arizona, AZ 85259, USA
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Polcwiartek C, Sneider B, Graff C, Taylor D, Meyer J, Kanters JK, Nielsen J. The cardiac safety of aripiprazole treatment in patients at high risk for torsade: a systematic review with a meta-analytic approach. Psychopharmacology (Berl) 2015; 232:3297-308. [PMID: 26231497 DOI: 10.1007/s00213-015-4024-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/01/2015] [Indexed: 01/08/2023]
Abstract
RATIONALE Certain antipsychotics increase the risk of heart rate-corrected QT (QTc) prolongation and consequently Torsades de Pointes (TdP) and sudden cardiac death (SCD). Drug-induced Brugada syndrome (BrS) is also associated with SCD. Most SCDs occur in patients with additional cardiac risk factors. OBJECTIVES Aripiprazole's cardiac safety has not been assessed in patients at high risk for torsade, where QTc prolongation risk is highly increased. METHODS MEDLINE, Embase, and The Cochrane Library were searched for preclinical, clinical, and epidemiological studies. Eligible studies were reviewed and cardiac safety data were extracted. Continuous and dichotomous QTc data were used in the meta-analysis. RESULTS Preclinical studies suggested that aripiprazole has limited affinity for the delayed rectifier potassium current. TdP was reported in two case reports and SCD was reported in one case report and one case series. No clinical studies assessing aripiprazole's cardiac safety in patients at high risk for torsade were found. No thorough QT (TQT) study with aripiprazole was found. The meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole and QTc prolongation risk was lower compared with placebo and active controls. Epidemiological studies linked aripiprazole to weak/moderate torsadogenicity. No studies were found associating aripiprazole with BrS suggesting low affinity for the fast sodium current. CONCLUSIONS Aripiprazole is a low-risk antipsychotic regarding cardiac safety in healthy patients. However, baseline and steady state electrocardiogram is recommended in patients at high risk for torsade due to marked QTc prolongation, absence of a TQT study, and lack of data in this group.
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Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015; 14:119-36. [PMID: 26043321 PMCID: PMC4471960 DOI: 10.1002/wps.20204] [Citation(s) in RCA: 515] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health SystemGlen Oaks, New York, NY, USA,Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of MedicineHempstead, New York, NY, USA,Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical ResearchManhasset, New York, NY, USA,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of MedicineBronx, New York, NY, USA
| | - Johan Detraux
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of LeuvenB-3000 Leuven, Belgium
| | - Marc De Hert
- Department of Neurosciences, Catholic University LeuvenB-3070 Kortenberg, Belgium
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Psychotropic drug-associated electrocardiographic presentation of diffuse J-waves in hypothermia: case report and literature review. Heart Vessels 2015; 31:996-1002. [PMID: 25666953 DOI: 10.1007/s00380-015-0646-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
The use of psychotropic drugs is often associated with electrocardiographic (ECG) QT-interval prolongation, but there are few reports of J-waves. This report describes the case of a schizophrenic patient under treatment with several psychotropic drugs (olanzapine, valproate, and flunitrazepam), in whom ECG J-waves diffusely appeared during a hypothermic episode. We further performed a literature review of psychotropic drug-related J-waves in hypothermia. The present case highlights the importance of recognizing psychotropic drug-related ECG J-waves on an early warning sign to ensure appropriate monitoring and/or treatment for possible life-threatening side effects of such medications.
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Affiliation(s)
- Dan M Roden
- From the Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
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