The Relationship Between Antipsychotic Drug Use and Electrocardiography Parameters
Year 2019,
Volume: 11 Number: Supplement 1 (Research Issue), 136 - 146, 29.12.2019
Mehmet Emin Demirkol
,
Lut Tamam
,
Soner Çakmak
,
Caner Yeşiloğlu
Abstract
Antipsychotic drugs have many known metabolic and cardiac effects. The aim of this study was to evaluate the relationship between electrocardiographic parameters and antipsychotic drug use in inpatients with psychotic disorder. For this purpose, electrocardiograms (ECG) of 200 psychotic patients who were hospitalized in our clinic were examined and the relationship between QTc interval, R-R distance and PR interval, the number of antipsychotic drugs used and the effect of antipsychotics on QTc were investigated. According to the data obtained, QTc intervals of the patients using multiple antipsychotic drugs were found to be significantly longer than those using monotherapy. When antipsychotic drugs were classified according to their potency on QTc, QTc intervals were found to be significantly longer in those receiving moderately effective drugs compared to lower effective drugs. In conclusion, considering the frequency of cardiovascular side effects in the follow-up and treatment of patients with psychotic disorder, multiple antipsychotic drugs use should be avoided as much as possible and drug selection should be given importance.
References
- Akbarzadeh MA, Yazdani S, Ghaidari ME, Asadpour PM, Bahrololoumi BN, Golabchi, A (2014) Acute effects of smoking on QT dispersion in healthy males. Arya atheroscler, 10(2):89-93.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- Asena AA, Örsel S, Karaoğlan A (2006) Antipsikotiklere Bağlı Metabolik Yan Etkiler. J Clin Psy, 9(1):5-6.
- Bazett HC (1930) An analysis of time relations of electrocardiograms. Heart 7:353–67.
- Botstein P (1993) Is QT interval prolongation harmful? A regulatory perspective. Am J Cardiol, 72:50–2.
- Ceylan D, Yesilyurt S. Akdede B, Sayin Z, Alptekin K (2016) The associations of the antipsychotic polypharmacy in schizophrenia treatment with the symptoms, side effects and the quality of life. Anatolian Journal of Psychiatry, 17(6):433-41.
- Clark RE, Bartels SJ, Mellman TA, Peacock WJ (2002) Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophr Bull, 28:76-84.
- Chong SA, Mythily, Mahendran R (2001) Cardiac Effects of Psychotropic Drugs. Ann Acad Med, 30:625-31.
- Czekalla J, Beasley CM, Dellva MA, Berg PH, Grundy S (2001) Analysis of the QTc Interval During Olanzapine Treatment of Patients With Schizophrenia and Related Psychosis. J. Clin. Psychiatry, 62:191-8.
- Di Sciascio G, Calo S, Amodio G, D’onofrio S, Pollice R (2011) The use of first generation versus second generation antipsychotics as add-on or as switch treatment and its effect on QTC interval: the Italian experience in a real-world setting. Int J Immunopathol Pharmacol, 24(1):225–30.
- Doll R, Peto R (1981) The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst, 66:1191-308.
- DuBuske LM (1999) Second-generation antihistamines: the risk of ventricular arrhythmias. Clin Ther, 21:281–95.
- Funck-Brentano, C, Jaillon P (1993). Rate-corrected QT interval: Techniques and limitations. The American Journal of Cardiology, 72(6):B17-B22.
- Glassman AH, Bigger JT Jr. (2001) Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry, 158:1774–82.
- Haddad PMi Anderson IM (2002) Antipsychotic‐related QTc prolongation, torsade de pointes and sudden death. Drugs, 62:1649–71.
- Harrigan E, Miceli J, Anziano R, Watsky E, Reeves K, Cutler N ve ark. (2004) A Randomized Evaluation of the Effects of Six Antipsychotic Agents on QTc, In the Absence and Presence of Metabolic Inhibition. Int Clin Psychopharmacol, 24(1):62-9.
- Harvey PD, Strassing M (2012) Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry, 11(2):73-9.
- Hennekens CH, Hennekens AR, Hollar D, Casey DE (2005a) Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150(6), 1115-1121.
- İlhan A, Özcan ME, Tuncer C, Kali S, Boztepe V, Pekdemir H (1999) Antipsikotik kullanımının ventriküler repolarizasyon parametreleri üzerine etkileri. Klinik Psikofarmakol Bulteni, 9:112-7.
- Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull, 13(2):261-76. Kostakoğlu E, Batur S, Tiryaki A, Göğüs A (1999) Pozitif ve negatif sendrom ölçeğinin (PANSS) Türkçe uyarlamasının geçerlik ve güvenilirliği. Türk Psikol Derg, 14:23-32.
- Kumsar N, Dilbaz N (2012) Practices of antipsychotic polypharmacy in schizophrenia: a review. Npakademi 1(1):28-37.
- Moss AJ (1993) Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol, 72:23-5.
- Moss AJ (1996) Correct the QT interval correctly: QTc should be expressed in the same unit as the QT interval. Pacing Clin Electrophysiol, 19:881–2
- Meyer JM, Loeber AD, Schweizer E (2009) Lurasidone: a new drug in development for schizophrenia. Expert Opin Investig Drugs, 18:1715–26.
- Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU (2010) 10-year trends in the treatment and outcomes of patients with first-episode schizophrenia. Acta Psychiatr Scand, 122(5):356-66.
- Özalmete ÖA, Özalmete OE, Ceylan ME, Sevim ME (2009) Şizofreni tedavisinde çoklu ilaç kullanımının nedenleri. Klinik Psikofarmakol Bulteni 2009, 19:68-74.
- Passman R, Kadish A (2001) Polymorphic ventricular tachycardia, long QT syndrome, and torsades de pointes. Med Clin North Am, 85:321-41.
- Stollberger C , Hubera JO, Finsterer J (2005) Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol, 20(5):243-51.
- Takeuchi H, Suzuki T, Remington G, Uchida H (2015) Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review. Can J Psychiatry, 60(5):215-22.
- Taylor DM (2003) Antipsychotics and QT prolongation. Acta Psychiatr Scand, 107:85–95.
- Van Noord C, Sturkenboom MC, Straus SM, Witteman JC, Stricker BH (2011) Noncardiovascular drugs that inhibit hERG-encoded potassium channels and risk of sudden cardiac death. Heart, 97(3):215–20.
- Vink SA, Sally ABC, Arthur AMW AB, Nico AB (2017) Effect of age and gender on the QTc-interval in healthy individuals and patients with Long-QT syndromeAge and gender on QTc interval. Trends in Cardiovascular Medicine, 28(1):64-75.
Antipsikotik İlaç Kullanımının Elektrokardiyografi Parametreleri ile İlişkisi
Year 2019,
Volume: 11 Number: Supplement 1 (Research Issue), 136 - 146, 29.12.2019
Mehmet Emin Demirkol
,
Lut Tamam
,
Soner Çakmak
,
Caner Yeşiloğlu
Abstract
Antipsikotik ilaçların bilinen birçok metabolik ve kardiyak etkisi bulunmaktadır. Bu çalışmanın amacı yatarak tedavi görmüş psikotik bozukluk tanılı hastaların elektrokardiyografik parametreleri ile antipsikotik ilaç kullanımı arasındaki ilişkiyi değerlendirmektir. Bu amaçla kliniğimizde yatmış olan 200 psikotik bozukluk hastasının elektokardiyografileri (EKG) incelenerek, QTc aralığı, R-R mesafesi ve PR aralığı ile kullanılan antipsikotik ilaç sayısı ve antipsikotiklerin QTc üzerine etkisinin gücünün ilişkisi araştırılmıştır. Elde edilen verilere göre çoklu antipsikotik ilaç kullananların QTc aralıklarının monoterapi kullananlara göre anlamlı olarak daha uzun olduğu saptanmıştır. Antipsikotik ilaçlar QTc üzerine etki güçlerine göre sınıflandırıldığında, orta şiddette etkili ilaç alanların düşük etkili ilaç alanlara göre QTc aralıklarının anlamlı olarak daha uzun olduğu saptanmıştır. Sonuç olarak psikotik bozukluk tanılı hastaların takibi ve tedavisinde kardiyovasküler yan etki sıklığı dikkate alındığında, çoklu antipsikotik ilaç kullanımından mümkün oldukça kaçınılmalı ve ilaç seçimine önem verilmelidir.
References
- Akbarzadeh MA, Yazdani S, Ghaidari ME, Asadpour PM, Bahrololoumi BN, Golabchi, A (2014) Acute effects of smoking on QT dispersion in healthy males. Arya atheroscler, 10(2):89-93.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- Asena AA, Örsel S, Karaoğlan A (2006) Antipsikotiklere Bağlı Metabolik Yan Etkiler. J Clin Psy, 9(1):5-6.
- Bazett HC (1930) An analysis of time relations of electrocardiograms. Heart 7:353–67.
- Botstein P (1993) Is QT interval prolongation harmful? A regulatory perspective. Am J Cardiol, 72:50–2.
- Ceylan D, Yesilyurt S. Akdede B, Sayin Z, Alptekin K (2016) The associations of the antipsychotic polypharmacy in schizophrenia treatment with the symptoms, side effects and the quality of life. Anatolian Journal of Psychiatry, 17(6):433-41.
- Clark RE, Bartels SJ, Mellman TA, Peacock WJ (2002) Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophr Bull, 28:76-84.
- Chong SA, Mythily, Mahendran R (2001) Cardiac Effects of Psychotropic Drugs. Ann Acad Med, 30:625-31.
- Czekalla J, Beasley CM, Dellva MA, Berg PH, Grundy S (2001) Analysis of the QTc Interval During Olanzapine Treatment of Patients With Schizophrenia and Related Psychosis. J. Clin. Psychiatry, 62:191-8.
- Di Sciascio G, Calo S, Amodio G, D’onofrio S, Pollice R (2011) The use of first generation versus second generation antipsychotics as add-on or as switch treatment and its effect on QTC interval: the Italian experience in a real-world setting. Int J Immunopathol Pharmacol, 24(1):225–30.
- Doll R, Peto R (1981) The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst, 66:1191-308.
- DuBuske LM (1999) Second-generation antihistamines: the risk of ventricular arrhythmias. Clin Ther, 21:281–95.
- Funck-Brentano, C, Jaillon P (1993). Rate-corrected QT interval: Techniques and limitations. The American Journal of Cardiology, 72(6):B17-B22.
- Glassman AH, Bigger JT Jr. (2001) Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry, 158:1774–82.
- Haddad PMi Anderson IM (2002) Antipsychotic‐related QTc prolongation, torsade de pointes and sudden death. Drugs, 62:1649–71.
- Harrigan E, Miceli J, Anziano R, Watsky E, Reeves K, Cutler N ve ark. (2004) A Randomized Evaluation of the Effects of Six Antipsychotic Agents on QTc, In the Absence and Presence of Metabolic Inhibition. Int Clin Psychopharmacol, 24(1):62-9.
- Harvey PD, Strassing M (2012) Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry, 11(2):73-9.
- Hennekens CH, Hennekens AR, Hollar D, Casey DE (2005a) Schizophrenia and increased risks of cardiovascular disease. American Heart Journal, 150(6), 1115-1121.
- İlhan A, Özcan ME, Tuncer C, Kali S, Boztepe V, Pekdemir H (1999) Antipsikotik kullanımının ventriküler repolarizasyon parametreleri üzerine etkileri. Klinik Psikofarmakol Bulteni, 9:112-7.
- Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull, 13(2):261-76. Kostakoğlu E, Batur S, Tiryaki A, Göğüs A (1999) Pozitif ve negatif sendrom ölçeğinin (PANSS) Türkçe uyarlamasının geçerlik ve güvenilirliği. Türk Psikol Derg, 14:23-32.
- Kumsar N, Dilbaz N (2012) Practices of antipsychotic polypharmacy in schizophrenia: a review. Npakademi 1(1):28-37.
- Moss AJ (1993) Measurement of the QT interval and the risk associated with QTc interval prolongation: a review. Am J Cardiol, 72:23-5.
- Moss AJ (1996) Correct the QT interval correctly: QTc should be expressed in the same unit as the QT interval. Pacing Clin Electrophysiol, 19:881–2
- Meyer JM, Loeber AD, Schweizer E (2009) Lurasidone: a new drug in development for schizophrenia. Expert Opin Investig Drugs, 18:1715–26.
- Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU (2010) 10-year trends in the treatment and outcomes of patients with first-episode schizophrenia. Acta Psychiatr Scand, 122(5):356-66.
- Özalmete ÖA, Özalmete OE, Ceylan ME, Sevim ME (2009) Şizofreni tedavisinde çoklu ilaç kullanımının nedenleri. Klinik Psikofarmakol Bulteni 2009, 19:68-74.
- Passman R, Kadish A (2001) Polymorphic ventricular tachycardia, long QT syndrome, and torsades de pointes. Med Clin North Am, 85:321-41.
- Stollberger C , Hubera JO, Finsterer J (2005) Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol, 20(5):243-51.
- Takeuchi H, Suzuki T, Remington G, Uchida H (2015) Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review. Can J Psychiatry, 60(5):215-22.
- Taylor DM (2003) Antipsychotics and QT prolongation. Acta Psychiatr Scand, 107:85–95.
- Van Noord C, Sturkenboom MC, Straus SM, Witteman JC, Stricker BH (2011) Noncardiovascular drugs that inhibit hERG-encoded potassium channels and risk of sudden cardiac death. Heart, 97(3):215–20.
- Vink SA, Sally ABC, Arthur AMW AB, Nico AB (2017) Effect of age and gender on the QTc-interval in healthy individuals and patients with Long-QT syndromeAge and gender on QTc interval. Trends in Cardiovascular Medicine, 28(1):64-75.