Frassati Dominique, Tabib Alain, Lachaux Bernard, Giloux Natalie, Daléry Jean, Vittori François, Charvet Dorothée, Barel Cécile, Bui-Xuan Bernard, Mégard Rachel, Jenoudet Louis Pierre, Descotes Jacques, Vial Thierry, Timour Quadiri
Centre Hospitalier le Vinatier, Bron, France.
Can J Psychiatry. 2004 Feb;49(2):100-5. doi: 10.1177/070674370404900204.
To confirm the hypothesis that psychotropic drugs, especially neuroleptics, lithium, and antidepressants, are implicated as a cause of unexpected sudden death in psychiatric patients because of their cardiotoxicity, especially when hidden cardiac lesions are present.
We performed a full pathological examination of 14 psychiatric patients who unexpectedly and suddenly died between 1980 and 1999.
Neuroleptics were involved in 13 instances, antidepressants in 9, and anxiolytics in 5. Psychotropic drugs were combined in all but a single patient. In all 14 patients, toxicological analyses discarded drug overdose as cause of death. At postmortem examination, the brain and abdominal organs were normal. In 13 patients, the following lesions were found in the heart and lungs: dilated cardiomyopathy (6 patients), left ventricular hypertrophy (2 patients, 1 of which was associated with mitral prolapse and anomalies of His bundle), arrhythmogenic cardiopathy of the right ventricle (1 patient), pericarditis (1 patient), mitral prolapse (1 patient), muscular bridge on the anterior interventricular artery (1 patient), and Mendelsons syndrome (1 patient). In 1 case, no changes were seen. Most of the drugs that were taken immediately prior to death can induce arrhythmias either by prolonging the QT interval, potentially resulting in torsades de pointes, or by widening QRS complexes, possibly leading to reentry and ventricular fibrillation.
Our findings suggest that the arrhythmogenic effects of psychotropic drugs can be exacer bated when preexisting hidden cardiac lesions are present and can result in sudden death. Patients should be systematically evaluated for cardiac lesions prior to starting any treatment with psychotropic drugs; the minimal effective dosage should be used.
证实以下假说，即精神药物，尤其是抗精神病药、锂盐和抗抑郁药，因其心脏毒性，尤其在存在隐匿性心脏病变时，与精神科患者意外猝死有关。
我们对1980年至1999年间意外猝死的14例精神科患者进行了全面的病理检查。
13例涉及抗精神病药，9例涉及抗抑郁药，5例涉及抗焦虑药。除1例患者外，所有患者均联合使用了精神药物。在所有14例患者中，毒理学分析排除了药物过量作为死因。尸检时，脑和腹部器官正常。13例患者的心脏和肺部发现以下病变：扩张型心肌病（6例）、左心室肥厚（2例，其中1例合并二尖瓣脱垂和希氏束异常）、右心室致心律失常性心肌病（1例）、心包炎（1例）、二尖瓣脱垂（1例）、前室间动脉肌桥（1例）和 Mendelson 综合征（1例）。1例未见变化。大多数在死亡前立即服用的药物可通过延长QT间期（可能导致尖端扭转型室速）或增宽QRS波群（可能导致折返和心室颤动）诱发心律失常。
我们的研究结果表明，当存在先前隐匿的心脏病变时，精神药物的致心律失常作用可能会加剧，并可能导致猝死。在开始使用任何精神药物治疗之前，应对患者进行系统的心脏病变评估；应使用最小有效剂量。
