Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
PLoS One. 2011;6(11):e26378. doi: 10.1371/journal.pone.0026378. Epub 2011 Nov 4.
Schizophrenia is associated with autonomic dysfunction and this may increase cardiovascular mortality. Past studies on autonomic modulation of schizophrenic patients focused on inpatients rather than individuals in a community setting, especially those receiving non-intensive case management (non-ICM). Besides, autonomic modulation and its association with health-related quality of life (HRQoL) in this population remain unexplored.
A total of 25 schizophrenic patients treated by non-ICM and 40 healthy volunteers were matched by age, gender and body mass index; smokers were excluded. Between the two groups, we compared the individuals' 5 min resting assessments of heart rate variability and their HRQoL, which was measured using EuroQoL-5D (EQ-5D). Patients with schizophrenia were assessed for psychopathology using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). We examined the relationship between heart rate variability measurements, HRQoL scores, PANSS scores, and other clinical variables among the schizophrenic patients treated by non-ICM.
Compared to the controls, patients with schizophrenia showed a significant impairment of autonomic modulation and a worse HRQoL. Cardiovagal dysfunction among the schizophrenic patients could be predicted independently based on lower educational level and more negative symptoms. Sympathetic predominance was directly associated with anticholinergics use and EQ-5D using a visual analogue scale (EQ-VAS).
Patients with schizophrenia treated by non-ICM show a significant impairment of their autonomic function and HRQoL compared to the controls. Since the sympathovagal dysfunction is associated with more negative symptoms or higher VAS score, the treatment of the negative symptoms as well as the monitoring of HRQoL might help to manage cardiovascular risk among these individuals. In addition, EQ-VAS scores must be interpreted more cautiously in such a population.
精神分裂症与自主神经功能障碍有关，这可能会增加心血管死亡率。过去关于精神分裂症患者自主神经调节的研究集中在住院患者，而不是社区环境中的个体，尤其是那些接受非强化病例管理（非 ICM）的患者。此外，该人群的自主神经调节及其与健康相关生活质量（HRQoL）的关系仍未得到探索。
共纳入 25 名接受非 ICM 治疗的精神分裂症患者和 40 名健康志愿者，按年龄、性别和体重指数进行匹配；排除吸烟者。在两组之间，我们比较了个体 5 分钟静息心率变异性评估和 HRQoL，使用 EuroQoL-5D（EQ-5D）进行测量。使用阳性和阴性综合征量表（PANSS）评估精神分裂症患者的精神病理学。我们检查了非 ICM 治疗的精神分裂症患者的心率变异性测量值、HRQoL 评分、PANSS 评分和其他临床变量之间的关系。
与对照组相比，精神分裂症患者的自主神经调节功能明显受损，HRQoL 更差。精神分裂症患者的心迷走神经功能障碍可以根据较低的教育水平和更多的阴性症状独立预测。交感神经优势与抗胆碱能药物的使用和使用视觉模拟量表（EQ-VAS）的 EQ-5D 直接相关。
与对照组相比，接受非 ICM 治疗的精神分裂症患者的自主功能和 HRQoL 明显受损。由于交感迷走神经功能障碍与更多的阴性症状或更高的 VAS 评分相关，因此治疗阴性症状以及监测 HRQoL 可能有助于管理这些个体的心血管风险。此外，在这种人群中，EQ-VAS 评分必须更谨慎地解释。
