QT and P-Wave Dispersion of Patients with Antisocial Personality Disorder

Öz

Background: The purpose was to examine the electrocardiographic arrhythmia risk determinants of the QT and P-wave dispersions of the patients who have Antisocial Personality Disorder (ASPD) by comparing them with the healthy control group. Method: A total of 52 patients who were diagnosed with ASPD according to DSM-5 Criteria and a healthy control group that consisted of 54 people were included in the study. Twelve lead Electrocardiograms (ECGs) were obtained from all participants in the supine position and at rest, and P-wave dispersion and QT dispersion were also calculated. The participants were administered the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Buss-Durke Aggression Scale (BDAS), Barratt Impulsivity Scale (BIS-11), and sociodemographic clinical data form. The SPSS version 22 package program was used for statistical analyses. Results: The mean age of the ASPD group and control group were no statistically significant differences between them (p=0.092). QT max (p=0.016), QTd (p<0.001), P max (p<0.001), and Pd (p<0.001) values of the ASPD group were higher than the values of the control group at significant levels; and QT min (p<0.001) and P min (p<0.001) values were found to be significantly lower. The BAI, BDI, BDAS scores and the motor impulsiveness score of the BIS-11 subscales of the ASPD group were significantly higher than those of the control group (p<0.001). Discussion: The findings of study showed that ASPD patients were at risk for electrical problems of the heart, especially cardiac arrhythmia, and this must be considered in the general psychiatric follow-up of these patients.

Anahtar Kelimeler

• antisocial personality disorder
• QT dispersion
• P dispersion

Antisosyal Kişilik Bozukluğu Olan Hastalarda QT ve P Dalgası Dispersiyonu

Öz

Amaç: Antisosyal kişilik bozukluğu (ASKB) olan hastalarda elektrokardiyografik aritmi risk belirleyicileri olan QT ve P dalgası dispersiyonlarının sağlıklı kontrol grubuyla karşılaştırılarak incelenmesi amaçlanmıştır. Yöntem: Çalışmamıza DSM-5 kriterlerine göre ASKB tanısı alan 52 hasta ve 54 kişiden oluşan sağlıklı kontrol grubu dahil edildi. Tüm katılımcıların boy, kiloları, tansiyonları ölçüldü ve vücud kitle indeksleri(VKİ) hesaplandı. Vücut kitle indeksi > 24,9 kg/m2 olan katılımcılar çalışma dışı bırakıldı. Tüm katılımcılardan on iki derivasyon elektrokardiyogramı (EKG) yatar pozisyonda ve istirahatte alındı. P dalga dispersiyonu ve QT dispersiyonu hesaplandı. Ayrıca katılımcılara Beck Anksiyete Ölçeği (BAÖ), Beck Depresyon Ölçeği (BDÖ), Buss-Durke Saldırganlık Ölçeği (BDSÖ), Barratt Dürtüsellik Ölçeği (BrDÖ) ve sosyodemografik klinik veri formu uygulandı. İstatiksel analizler için SPSS versiyon 22 paket programı kullanıldı. Sonuçlar: ASKB grubunda bulunanların yaş ortalaması 29,6±6,5, kontrol grubunun yaş ortalaması ise 31,8±7,1 olarak bulunmuş olup aralarında istatistiksel olarak anlamlı farklılık görülmemiştir (p=0,092). ASKB grubunun QT max (p=0,016), QT disp (p<0,001), P max (p<0,001), P disp (p<0,001) değeri kontrol grubunun değerlerinden anlamlı şekilde yüksek; QT min (p<0,001) ve P min (p<0,001) değeri ise anlamlı şekilde düşük bulunmuştur. ASKB grubunun BAÖ ve BDÖ puanı kontrol grubunun puanından anlamlı şekilde yüksek bulunmuştur (p<0,001). BDSÖ tüm alt ölçek puanları kontrol grubuna kıyasla daha yüksekti (p<0,001), BrDÖ alt ölçeklerinden ise motor dürtüsellik puanı ASKB grubunda daha yüksekti (p<0,001). Tartışma: Çalışma bulgularımız ASKB hastalarının kardiyak aritmi başta olmak üzere kalbin elektriksel temelli sorunları açısından risk taşıdıkları ve bu durumun bu hastaların genel psikiyatrik takibinde göz önünde bulundurulması gerektiğini göstermektedir.

Anahtar Kelimeler

• antisosyal kişilik bozukluğu
• QT dispersiyonu
• P dispersiyonu

Kaynakça

1. 1. Paris J, Chenard-Poirier MP, Biskin R. Antisocial and borderline personality disorders revisited. Compr Psychiatry 2013; 54:321– 325. DOI: 10.1016/j.comppsych.2012.10.006
2. 2. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Washington, DC, American Psychiatric Association, 2013.
3. 3. Köroğlu E, Güleç C. Psikiyatri Temel Kitabı. İkinci baskı, Ankara: HYB Basım Yayın, 2007.
4. 4. Moffitt TE. Genetic and environmental influences on antisocial behaviors: evidence from behavioral-genetic research. Adv Genet 2005; 55:41-104. doi: 10.1016/S0065-2660(05)55003-X. PMID: 16291212.
5. 5. Van Goosen, SHM, Matthys W, Cohen-Kettenis PT. Salivary Cortisol and cardiovascular activity duringstress in oppositional defiant disorder boys and normal controls, Biological Psychiatry 1998; 43: 531-539. DOI: 10.1016/S0006-3223(97)00253-9.
6. 6. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000; 36(6):1749–1766. DOI:10.1016/s0735-1097(00)00962-1.
7. 7. Perzanowski C, Ho AT, Jacobson AK. Increased P-wave dispersion predicts recurrent atrial fibrillation after cardioversion. J Electrocardiol 2005;38:43–46. doi:10.1016/j.jelectrocard.2004.09.008
8. 8. Schocken K. The analysis of the normal QT interval. Exp Med Surg 1955; 13(3):258–260.

9. 9. Riis P. Perspectives on the Fifth Revision of the Declaration of Helsinki. JAMA 2000;284(23):3045-3046. DOI: 10.1001/jama.284.23.3045
10. 10. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory form measuring depression. Arch Gen Psychiatry 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004
11. 11. Hisli, N. Beck Depresyon Envanterinin Geçerliği Üzerine Bir Çalışma. Psikoloji Dergisi 1989;22:118-26.
12. 12. Beck AT, Epstein N, Brown G, Steer RA. An inventory form measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology 1988;56:893–7. DOI: 10.1037/0022-006X.56.6.893
13. 13. Ulusoy M, Şahin N, Erkman H. Turkish version of the beck anxiety inventory: psychometric properties. J Cognitive Psychotherapy 1998;12:28-35.
14. 14. H Güleç, L Tamam, MY Güleç, M Turhan, G Karakuş, M Zengin, MS Stanford. Barratt dürtüsellik ölçeği -11 (BIS-11)’nin Türkçe uyarlamasının psikometrik özellikleri. Klinik Psikofarmakoloji Bülteni 2008;18:251-258.
15. 15. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J ClinPsychol 1995;51:768-774. DOI: 10.1002/1097-4679(199511)51:6<768::aid-jclp2270510607>3.0.co;2-1
16. 16. Buss AH, Durkee A. An inventory for assessing different kinds of hostility. J Consult Psychol 1957;21:343–349. DOI: 10.1037/h0046900
17. 17. Can S. “Aggression questionnaire” Adlı Ölçeğin Türk Popülasyonunda Geçerlilik ve Güvenilirlik Çalışması. Genel Kurmay Başkanlığı, Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi Ruh Sağlığı ve Hastalıkları Servis Şefliği, Unpublished Dissertation Thesis, İstanbul, 2002.
18. 18. Robyns T, Willems R, Vandenberk B, et al. Individualized corrected QT interval is superior to QT interval corrected using the Bazett formula in predicting mutation carriage in families with long QT syndrome. Heart Rhythm 2017;14(3):376-382. DOI: 10.1016/j.hrthm.2016.11.034
19. 19. Rautaharju PM, Surawicz B, Gettes LS, et al. American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 2009;119(10):e241-e250. DOI: 10.1016/j.jacc.2008.12.014
20. 20. Somberg JC, Molnar J. Usefulness of QT dispersion as an electrocardiographically derived index. Am J Cardiol 2002;89(3):291-294. DOI: 10.1016/s0002-9149(01)02230-5
21. 21. World Health Organisation. BMI Classification. Available at: http://who.int/bmi/index.jsp?introPage=intro_3.html Accessed November 25, 2016.
22. 22. Izci F, Hocagil H, Izci S, et al. P-wave and QT dispersion in patients with conversion disorder. Ther Clin Risk Manag 2015;11:475-480. DOI: 10.2147/TCRM.S81852
23. 23. Nahshoni E, Gur S, Marom S, Levin JB, Weizman A, Hermesh H. QT dispersion in patients with social phobia. J Affect Disord 2004;78(1):21–26. DOI: 10.1016/s0165-0327(02)00052-6
24. 24. Takimoto Y, Yoshiuchi K, Akabayashi A. Effect of mood states on QT interval and QT dispersion in eating disorder patients. Psychiatry Clin Neurosci 2008;62(2):185–189. DOI: 10.1111/j.1440-1819.2008.01753.x
25. 25. Kelmanson IA. High anxiety in clinically healthy patients and increased QT dispersion: a meta-analysis. Eur J Prev Cardiol 2014;21(12):1568–1574. DOI: 10.1177/2047487313501613
26. 26. Tosu, A. R., Demir, S., Kaya, Y., Selcuk, M., Asker, M., Özdemir, M., & Tenekecioglu, E. Increased QT dispersion and P wave dispersion in major depressive disorder. Experimental & Clinical Cardiology 2013; 18(2), 110.
27. 27. Yilmaz, M., & Yilmaz, S. Major depressive disorder is an independent predictor of the electrocardiographic frontal QRS-T angle. Bratislavske Lekarske Listy 2023. DOI: 10.4149/bll_2023_048
28. 28. Gurok MG, Korkmaz H, Yıldız S, Bakış D, Atmaca M. QT and P-wave dispersion during the manic phase of bipolar disorder. Neuropsychiatr Dis Treat 2019;15:1805-1811. Published 2019 Jul 3. DOI :10.2147/NDT.S208253
29. 29. Tran H, White CM, Chow MS, Kluger J. An evaluation of the impact of gender and age on QT dispersion in healthy subjects. Ann Noninvasive Electrocardiol 2001;6(2):129–133. DOI: 10.1111/j.1542-474x.2001.tb00097.x
30. 30. Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder. J Affect Disord 2013;148:384–390. DOI: 10.1016/j.jad.2012.06.027
31. 31. Bomba, M., Nicosia, F., Riva, A. et al. QTc dispersion and interval changes in drug-free borderline personality disorder adolescents. Eur Child Adolesc Psychiatry 29, 199–203 (2020). https://doi.org/10.1007/s00787-019-01343-3
32. 32. Dilaveris PE, Gialafos EJ. P wave dispersion: a novel predictor of paroxysmal AF. Ann Noninvasive Electrocardiol 2001;6:159–165. DOI: 10.1111/j.1542-474x.2001.tb00101.x
33. 33. Aytemir K, Ozer N, Atalar E, et al. Dispersion on 12 lead electrocardiography in patients with paroxysmal atrial fibrillation. PACE 2000;23:109–112. DOI: 10.1111/j.1540-8159.2000.tb00910.x
34. 34. Uyarel H, Kasikcioglu H, Dayi SU, et al. Anxiety and P wave dispersion in a healthy young population. Cardiology 2005;104:162–168. DOI: 10.1159/000087874
35. 35. Atmaca M, Korkmaz H, Korkmaz S. P wave dispersion in patients with hypochondriasis. Neurosci Lett 2010;485(3):148–150. DOI: 10.1016/j.neulet.2010.08.071
36. 36. Yavuzkir M, Atmaca M, Dagli N, et al. P wave dispersion in panic disorder. Psychosom Med 2007;69:344–347. DOI: 10.1097/PSY.0b013e3180616900
37. 37. Yokoyama A, Ishii H, Takagi T, et al. Prolonged QT interval in alcoholic autonomic nervous dysfunction. Alcohol Clin Exp Res 1992;16(6):1090-1092. DOI: 10.1111/j.1530-0277.1992.tb00703.x
38. 38. Corović N, Duraković Z, Misigoj-Duraković M. Dispersion of the corrected QT and JT interval in the electrocardiogram of alcoholic patients. Alcohol Clin Exp Res 2006;30(1):150-154. DOI: 10.1111/j.1530-0277.2006.00018.x
39. 39. Whitman IR, Agarwal V, Nah G, et al. Alcohol abuse and cardiac disease. J Am Coll Cardiol 2017;69(1):13-24. DOI: 10.1016/j.jacc.2016.10.048
40. 40. Baykara S, Ocak D, Berk SS, et al. Analysis of QT dispersion, corrected QT dispersion, and P-wave dispersion values in alcohol use disorder patients with excessive alcohol use. Prim Care Companion CNS Disord 2020;22(1):19m02541. DOI: 10.4088/PCC.19m02541
41. 41. M. Cima, T. Smeets, M. Jelicic. Self-reported trauma, cortisol levels, and aggression in psychopathic and non-psychopathic prison inmates Biol. Psychol 2008;78:75-86, 10.1016/j.biopsycho.2007.12.011. DOI: 10.1016/j.biopsycho.2007.12.011
42. 42. J. van Honk, D.J. Schutter. From affective valence to motivational direction: the frontal asymmetry of emotion revised Psychol. Sci 2006;17:963-965, DOI: 10.1111/j.1467-9280.2006.01813.x
43. 43. Loomans MM, Tulen JH, de Rijke YB, van Marle HJ. A hormonal approach to anti-social behaviour. Crim Behav Ment Health 2016;26(5):380–394. DOI: 10.1002/cbm.1968.
44. 44. Sahar Sobhani, Sara, Raji, Atena Aghaee, Parisa Pirzadeh, Elahe Ebrahimi Miandehi, Susan Shafiei, Masoumeh Akbari, Saeid Eslami, Body mass index, lipid profile, and hypertension contribute to prolonged QRS complex, Clinical Nutrition ESPEN, Volume 50, 2022, Pages 231-237, ISSN 2405-4577, https://doi.org/10.1016/j.clnesp.2022.05.011.
45. 45. Seyfeli, E., Duru, M., Kuvandık, G. et al. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes 30, 957–961 (2006). https://doi.org/10.1038/sj.ijo.0803233
46. 46. Mangoni AA, Kinirons MT, Swift CG, Jackson SH. Impact of age on QT interval and QT dispersion in healthy subjects: a regression analysis. Age Ageing. 2003;32(3):326-31.
47. 47. Macfarlane PW, McLaughlin SC, Rodger C. Influence of lead selection and population on automated measurement of QT dispersion. Circulation 1998; 98: 2160–7