Mackin Paul
School of Neurology, Neurobiology and Psychiatry, Newcastle University, Leazes Wing (Psychiatry), Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Hum Psychopharmacol. 2008 Jan;23 Suppl 1:3-14. doi: 10.1002/hup.915.
This review describes the common effects of psychotropic drugs on the cardiovascular system and offers guidance for practical management. Selected reports from the literature describing common side effects associated with psychotropic drugs are reviewed, and suggestions for further reading are given throughout the text. Orthostatic hypotension is the most common adverse autonomic side effect of antipsychotic drugs. Among the atypical antipsychotics the risk of orthostatic hypotension is highest with clozapine and among the conventional drugs the risk is highest with low potency agents. Rarely, orthostatic hypotension may result in neurocardiogenic syncope. QTc prolongation can occur with all antipsychotics but an increased risk is seen with pimozide, thioridazine, sertindole and zotepine. QTc prolongation is a marker of arrhythmic risk. Torsade de pointe, a specific arrhythmia, may lead to syncope, dizziness or ventricular fibrillation and sudden death. Heart muscle disease presents most commonly in the elderly as chronic heart failure, but myocarditis and cardiomyopathy, although relatively rare, are devastating, but potentially reversible complications of psychotropic drug therapy have been particularly linked to clozapine treatment. Patients with severe mental illness (SMI) are a 'high risk' population with regard to cardiovascular morbidity and mortality. It is probable that many patients accumulate an excess of 'traditional' risk factors for the development of cardiovascular disease, but other mechanisms including psychotropic drugs may also be influential in increasing risk in this vulnerable group. These risks need to be seen in the context of the undoubted therapeutic efficacy of the psychotropic armamentarium and the relief that these drugs bring to those suffering from mental disorder.
本综述描述了精神药物对心血管系统的常见影响，并提供了实际管理的指导。回顾了文献中描述精神药物相关常见副作用的部分报告，并在全文中给出了进一步阅读的建议。体位性低血压是抗精神病药物最常见的自主神经副作用。在非典型抗精神病药物中，氯氮平导致体位性低血压的风险最高，而在传统药物中，低效价药物导致体位性低血压的风险最高。体位性低血压很少会导致神经心源性晕厥。所有抗精神病药物都可能导致QTc延长，但匹莫齐特、硫利达嗪、舍吲哚和佐替平的风险更高。QTc延长是心律失常风险的一个指标。尖端扭转型室速是一种特定的心律失常，可能导致晕厥、头晕或室颤及猝死。心肌疾病在老年人中最常见的表现为慢性心力衰竭，但心肌炎和心肌病虽然相对罕见，但却是毁灭性的，不过精神药物治疗的潜在可逆性并发症尤其与氯氮平治疗有关。严重精神疾病（SMI）患者在心血管发病和死亡方面属于“高危”人群。很可能许多患者积累了过多“传统”的心血管疾病危险因素，但包括精神药物在内的其他机制也可能影响这一弱势群体的风险增加。在精神药物无疑具有治疗效果以及这些药物给精神障碍患者带来缓解的背景下，需要审视这些风险。
