Edinoff Amber N, Ellis Emily D, Nussdorf Laura M, Hill Taylor W, Cornett Elyse M, Kaye Adam M, Kaye Alan D
Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA.
School of Medicine, Louisiana State University Shreveport, Shreveport, LA 71103, USA.
Neurol Int. 2022 Mar 17;14(1):294-309. doi: 10.3390/neurolint14010024.
Schizophrenia is a psychotic disorder that exists at the more extreme end of a spectrum of diseases, and significantly affects daily functioning. Cardiovascular adverse effects of antipsychotic medications are well known, and include changes in blood pressure and arrhythmias. Sudden cardiac death is the leading cause of death worldwide, and antipsychotic medications are associated with numerous cardiac side effects. A possible link exists between antipsychotic medications and sudden cardiac death. Common prescribing patterns that may influence cardiovascular events include the use of multiple antipsychotics and/or additional drugs commonly prescribed to patients on antipsychotics. The results of this review reflect an association between antipsychotic drugs and increased risk of ventricular arrhythmias and sudden cardiac death by iatrogenic prolongation of the QTc interval. QTc prolongation and sudden cardiac death exist in patients taking antipsychotic monotherapy. The risk increases for the concomitant use of specific drugs that prolong the QTc interval, such as opioids, antibiotics, and illicit drugs. However, evidence suggests that QTc intervals may not adequately predict sudden cardiac death. In considering the findings of this narrative review, we conclude that it is unclear whether there is a precise association between antipsychotic polypharmacy and sudden cardiac death with QTc interval changes. The present narrative review warrants further research on this important potential association.
精神分裂症是一种存在于一系列疾病较极端一端的精神障碍，会显著影响日常功能。抗精神病药物的心血管不良反应是众所周知的，包括血压变化和心律失常。心源性猝死是全球主要的死亡原因，抗精神病药物与众多心脏副作用相关。抗精神病药物与心源性猝死之间可能存在联系。可能影响心血管事件的常见处方模式包括使用多种抗精神病药物和/或通常给服用抗精神病药物的患者开具的其他药物。本综述的结果反映了抗精神病药物与因医源性QTc间期延长导致室性心律失常和心源性猝死风险增加之间的关联。服用抗精神病单药治疗的患者存在QTc延长和心源性猝死情况。同时使用延长QTc间期的特定药物（如阿片类药物、抗生素和非法药物）时风险会增加。然而，有证据表明QTc间期可能无法充分预测心源性猝死。考虑到本叙述性综述的结果，我们得出结论，抗精神病药物联合使用与因QTc间期变化导致的心源性猝死之间是否存在确切关联尚不清楚。本叙述性综述值得对这一重要的潜在关联进行进一步研究。
