Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland.
Department of Cardiology, King's College Hospital NHS Foundation Trust, United Kingdom.
Gen Hosp Psychiatry. 2020 Nov-Dec;67:83-91. doi: 10.1016/j.genhosppsych.2020.09.003. Epub 2020 Oct 6.
Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls.
We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD.
Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation.
Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.
精神分裂症患者心血管发病率过高，心脏性猝死（SCD）的发生率增加，导致其过早死亡。Brugada 综合征（BrS）是 SCD 的一个重要但未被充分认识的原因。与一般人群对照相比，BrS 在精神分裂症患者中更为常见。
我们进行了范围综述，以描述 BrS 在精神分裂症中的发病机制，并确定增加揭示 BrS 风险的精神药物以及导致 SCD 的相关室性心律失常。
精神分裂症和 BrS 具有相似的钙通道异常，这可能导致心肌电导率异常。目前尚不确定精神分裂症患者中是否存在 BrS 的遗传易感性。然而，某些抗精神病药和抗抑郁药的使用会使 Brugada 心电图模式显现，从而增加引发 SCD 的风险，而与 QT 延长无关。
对于精神分裂症中先天性或显现的 Brugada 心电图模式，可能需要进行特定的心脏病学评估和干预。目前 BrS 的长期标准治疗是植入式心脏复律除颤器（ICD），但必须考虑植入后的心理影响。需要谨慎使用抗精神病药和其他精神药物，以尽量减少对心脏钠离子和钙离子通道的致心律失常作用。当为精神分裂症患者开此类药物时，临床医生应注意 Brugada 心电图模式的潜在致命显现及其管理方法。我们为治疗此类患者人群的精神科医生提出了建议。
