Stogios Nicolette, Gdanski Alexander, Gerretsen Philip, Chintoh Araba F, Graff-Guerrero Ariel, Rajji Tarek K, Remington Gary, Hahn Margaret K, Agarwal Sri Mahavir
Institute of Medical Science, University of Toronto, Toronto, Canada.
Center for Addiction and Mental Health (CAMH), Toronto, Canada.
NPJ Schizophr. 2021 Apr 26;7(1):22. doi: 10.1038/s41537-021-00151-6.
Schizophrenia (SCZ) is a psychiatric disorder characterized by a wide range of positive, negative and cognitive symptoms, along with an increased risk of metabolic syndrome and cardiovascular disease that contribute to a 15-20-year reduced life expectancy. Autonomic dysfunction, in the form of increased sympathetic activity and decreased parasympathetic activity, is postulated to be implicated in SCZ and its treatment. The aim of this narrative review is to view SCZ through an autonomic lens and synthesize the evidence relating autonomic dysfunction to different domains of SCZ. Using various methods of assessing autonomic activity, autonomic dysfunction was found to be associated with multiple aspects of SCZ pathophysiology, including symptom severity, cognitive impairment, and the development of cardiometabolic comorbidities, such as metabolic syndrome and high BMI. The strongest association of low heart rate variability was noted among patients on antipsychotic treatment with high-affinity muscarinic antagonism (i.e., clozapine, olanzapine and quetiapine). The review will also suggest ways in which studying autonomic dysfunction can help reduce morbidity and mortality associated with SCZ and its treatment.
精神分裂症（SCZ）是一种精神障碍，其特征为广泛的阳性、阴性和认知症状，同时患代谢综合征和心血管疾病的风险增加，这导致预期寿命缩短15至20年。自主神经功能障碍表现为交感神经活动增加和副交感神经活动减少，据推测与SCZ及其治疗有关。本叙述性综述的目的是从自主神经角度审视SCZ，并综合自主神经功能障碍与SCZ不同领域相关的证据。通过使用各种评估自主神经活动的方法，发现自主神经功能障碍与SCZ病理生理学的多个方面相关，包括症状严重程度、认知障碍以及心脏代谢合并症（如代谢综合征和高体重指数）的发生。在接受具有高亲和力毒蕈碱拮抗作用的抗精神病药物治疗的患者（即氯氮平、奥氮平和喹硫平）中，观察到心率变异性降低的关联最为强烈。该综述还将提出研究自主神经功能障碍有助于降低与SCZ及其治疗相关的发病率和死亡率的方法。
