Narang Puneet, El-Refai Mostafa, Parlapalli Roop, Danilov Lilia, Manda Sainath, Kaur Gagandeep, Lippmann Steven
Dr. Narang is from Hennepin County Medical Center, Minneapolis, Minnesota; Drs. El-Refai, Parlapalli, Danilov, Manda, Kaur, and Lippmann are from University of Louisville School of Medicine, Louisville, Kentucky.
Psychiatry (Edgmont). 2010 Oct;7(10):25-9.
Sudden cardiac death has become a significant clinical concern when prescribing antipsychotic drugs, especially to older people with dementia. Sudden death syndrome has been known for decades to occur in association with taking first-generation antipsychotic medications, but it has become more prominent recently due to safety reviews about the use of second-generation antipsychotic medications. In 2005, the United States Food and Drug Administration disseminated information about cardiac fatalities, which led to black box warnings in second-generation, antipsychotic, drug-prescribing literature about higher mortality when administering to elderly persons with dementia-related psychoses. In this population, treatment results in death rates of 4.5 percent, as compared to 2.6 percent in subjects taking a placebo. Actually, patients treated with both the first- and second-generation versions experienced an increased incidence of fatalities. Before utilizing these agents, a careful workup must be completed. The presence of a psychosis or mania should be the only conventional indication for prescribing first- and second-generation antipsychotic medications. Physicians should always evaluate patients for comorbid conditions, especially heart disease and metabolic abnormalities, and all currently used medications to assure a risk-to-benefit ratio favoring the application of an antipsychotic medication. An electrocardiogram is a part of the evaluation of the cardiac status and determines the base line QT interval. While prescribing these medications in elderly patients, physicians must provide individualized clinical, electrocardiographic, and pharmaceutical monitoring.
在开具抗精神病药物处方时，尤其是给患有痴呆症的老年人开药时，心源性猝死已成为一个重大的临床问题。几十年来，已知猝死综合征与服用第一代抗精神病药物有关，但由于对第二代抗精神病药物使用的安全性审查，该综合征最近变得更加突出。2005年，美国食品药品监督管理局发布了有关心脏死亡的信息，这导致第二代抗精神病药物处方文献中出现黑框警告，提示给患有痴呆相关精神病的老年人用药时死亡率更高。在这一人群中，治疗导致的死亡率为4.5%，而服用安慰剂的受试者死亡率为2.6%。实际上，接受第一代和第二代药物治疗的患者死亡率均有所增加。在使用这些药物之前，必须完成仔细的检查。精神病或躁狂的存在应该是开具第一代和第二代抗精神病药物的唯一常规指征。医生应始终评估患者是否存在合并症，尤其是心脏病和代谢异常，以及所有目前正在使用的药物，以确保抗精神病药物应用的风险效益比合理。心电图是心脏状况评估的一部分，可确定基线QT间期。在给老年患者开具这些药物时，医生必须提供个性化的临床、心电图和药学监测。
