Phenothiazine treatment and electrocardiographic abnormalities

A Summary of Current Information, Mechanisms and Treatment

Adverse reactions and the possible mechanisms of the reactions caused by antipsychotics are reviewed. The mechanisms of many of these adverse reactions have not been elucidated to date, hence there have been inconsistent approaches to the problem. Complicated symptoms of the reactions, especially exacerbation of the mental state, are often considered to be a part of the psychosis under treatment. Some of the reactions are temporary, or the patient may develop tolerance to them so that an additional drug may not be necessary.

It is suggested that use of the minimum dosage of antipsychotics, avoidance of polypharmacy, and close observation of the patient constitute the best approach to the prevention of unwanted reactions.

Heart and mind: (2) psychotropic and cardiovascular therapeutics

There is a plausible biological basis for the association between psychiatric morbidity and cardiovascular disease. Anxiety, panic disorder, and depression are common in patients with coronary heart disease and hypertension. Despite this evidence there is poor recognition of anxiety disorders and depression in primary care and hospital medical practice. Concern also surrounds the use of psychotropic drugs in patients with cardiovascular disease. In the first of the two articles on this subject, we highlighted the current evidence regarding the association between cardiovascular and psychotropic conditions. In this second article, we discuss the interaction of the drugs used in the management of these two varied but commonly coexistent group of diseases as well as their relative effects on either system. Finally, we summarise the data regarding the safe use of these medications based on the recommendations from the currently available evidence.