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Electrocardiographic abnormalities and psychotropic polypharmacy in schizophrenia and schizoaffective disorders

Srinivasan Tirupati1, Sachal Gulati2

  • 1Psychiatric Rehabilitation Service, Hunter New England Mental Health, Morisset, NSW, Australia; and School of Public Health and Medicine, Faculty of Health, The University of Newcastle, Callaghan, NSW, Australia.

Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists
|November 29, 2021
PubMed

Insights

Sudden cardiac death is a risk for schizophrenia patients. Many patients have electrocardiogram (ECG) abnormalities, not just prolonged QTc, indicating potential arrhythmia risks needing evaluation.

Area of Science:

  • Cardiology
  • Psychiatry
  • Pharmacology

Background:

  • Sudden cardiac death (SCD) is a major cause of mortality in individuals with schizophrenia and schizoaffective disorders.
  • Cardiac arrhythmias are a known cause of SCD, and electrocardiogram (ECG) abnormalities can predict these arrhythmias.
  • Antipsychotic drug use has been linked to ECG abnormalities.

Purpose of the Study:

  • To examine the types and frequency of ECG abnormalities (ECG-Abs) in patients with schizophrenia and schizoaffective disorder.
  • To investigate the association of ECG-Abs with demographic factors and psychotropic drug prescriptions.

Main Methods:

  • A chart audit was conducted on 169 patients in a long-stay inpatient unit.
  • Statistical analyses included chi-square test, Fisher's Exact test, independent two-sample t-test, Pearson's correlation, and one-way ANOVA.
  • ECG abnormalities were assessed in relation to demographic details and psychotropic medication.

Main Results:

  • Over half of the patients (52.1%) exhibited at least one ECG abnormality.
  • A significant portion (20.7%) had two or more ECG abnormalities.
  • The use of multiple antipsychotics, with or without other psychotropic drugs, did not show a significant association with the presence or number of ECG abnormalities.

Conclusions:

  • A substantial number of patients with schizophrenia and schizoaffective disorder present with ECG abnormalities beyond prolonged QTc interval, potentially predisposing them to cardiac arrhythmias.
  • These ECG abnormalities are not exclusive to patients on psychotropic polypharmacy.
  • Comprehensive ECG evaluation is recommended for all patients to identify arrhythmia risk, considering a range of electrical abnormalities.
Abstract

Keywords:
cardiac arrhythmiaelectrocardiogrampsychotropic drugsschizoaffective disorderschizophreniasudden cardiac death

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