Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
PLoS One. 2018 Jul 17;13(7):e0199922. doi: 10.1371/journal.pone.0199922. eCollection 2018.
It has long been known that antipsychotic drugs (ATP) causes tachycardia, however details such as the differences between ATP are not well known. In recent years, the relationship between the rise in resting heart rate (RHR) and the increased risk of death in the general population has been garnering attention. In this study, we examined the difference in action on RHR between olanzapine (OLZ) and aripiprazole (ARP). The changes in the RHR on switching from OLZ to ARP and on increasing from the starting OLZ dose to the final one were evaluated in 19 outpatients (Study 1) and in 29 outpatients with schizophrenia (Study 2), respectively. To analyze the RHR, electrocardiographic measurements were obtained. At the same day, the Brief Psychiatric Rating Scale (BPRS) was evaluated, and fasting blood samples were drawn after an overnight fast of at least 8 h to examine electrolytes. Both Study 1 and 2 were conducted with the approval of the Gene Ethics Committee of Niigata University Graduate School of Medical and Dental Sciences, and the patients were treated at the outpatient psychiatric clinic at Niigata University Medical and Dental Hospital. All patients had been diagnosed with schizophrenia based on the DSM-IV-TR. In the Study 1, OLZ of 14.6 ± 9.2mg (mean ± standard deviation) was switched to ARP of 20.8 ± 8.1mg. Significant decreases were observed in the mean RHR after the switch to ARP (73.7 ± 9.7 vs 65.8 ± 10.9 beats/min, p = 0.008). In the Study 2, the starting OLZ dose was 7.2 ± 3.2mg and the increasing OLZ dose was 18.3 ± 7.4mg. Significant increases were observed in the mean RHR after increasing OLZ (69.7 ± 14.0 vs 75.6 ± 14.3 beats/min, p = 0.004). In this study, it was shown that OLZ has a stronger RHR enhancing effect compared to ARP and its effects are dose-dependent. If the increase in RHR increases the mortality rate of patients with schizophrenia, it may be necessary to further investigate the differences between ATP in terms of the effect on RHR of second-generation antipsychotics with a strong anticholinergic action or phenothiazine antipsychotics.
长期以来，人们一直知道抗精神病药物（ATP）会导致心动过速，但是 ATP 之间的差异等细节并不为人所知。近年来，静息心率（RHR）升高与普通人群死亡风险增加之间的关系引起了人们的关注。在这项研究中，我们研究了奥氮平（OLZ）和阿立哌唑（ARP）对 RHR 作用的差异。在 19 名门诊患者（研究 1）和 29 名精神分裂症门诊患者（研究 2）中，分别评估了从 OLZ 切换到 ARP 时 RHR 的变化，以及从起始 OLZ 剂量增加到最终剂量时 RHR 的变化。为了分析 RHR，进行了心电图测量。同日，评估简明精神病评定量表（BPRS），并在禁食至少 8 小时后抽取空腹血样，以检查电解质。两项研究均得到了新泻大学研究生院医学和牙科科学基因伦理委员会的批准，患者在新泻大学医学和牙科医院的门诊精神病诊所接受治疗。所有患者均根据 DSM-IV-TR 诊断为精神分裂症。在研究 1 中，将 14.6 ± 9.2mg（平均值±标准差）的 OLZ 切换到 20.8 ± 8.1mg 的 ARP。转换为 ARP 后，平均 RHR 显著下降（73.7 ± 9.7 与 65.8 ± 10.9 次/分钟，p=0.008）。在研究 2 中，起始 OLZ 剂量为 7.2 ± 3.2mg，递增 OLZ 剂量为 18.3 ± 7.4mg。增加 OLZ 后，平均 RHR 显著升高（69.7 ± 14.0 与 75.6 ± 14.3 次/分钟，p=0.004）。在这项研究中，与 ARP 相比，OLZ 具有更强的 RHR 增强作用，其作用具有剂量依赖性。如果 RHR 的增加增加了精神分裂症患者的死亡率，那么可能需要进一步研究第二代具有强烈抗胆碱能作用或吩噻嗪类抗精神病药物的 ATP 对 RHR 的影响差异。
