Elevated Rest Heart Rate in Psychiatric Patients and Different Effects of Psychotropic Medication

Sarlon, Jan; Habich, O; Schneider, Barbara

doi:10.1055/s-0035-1565204

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…There were studies that heart rate has increased as people gain weight [ 9 – 10 ]. Conversely, recent study showed that the presence or absence of obesity did not affect RHR in patients with schizophrenia [ 11 ]. In any case, the change in body weight did not affect RHR in this study.…”

Section: Discussionmentioning

confidence: 98%

Effects of olanzapine on resting heart rate in Japanese patients with schizophrenia

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 98%

Effects of olanzapine on resting heart rate in Japanese patients with schizophrenia

et al. 2018

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“…Most SSRIs have been associated with a reduction in basal heart rate [70,71,72], even though a recent large study has found the opposite (an increase in heart rate associated with the use of SSRIs) [73]. On the contrary, the use of SNRIs (e.g.…”

Section: Cardiovascularmentioning

confidence: 99%

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Carvalho

Sharma²,

Brunoni³

et al. 2016

Psychother Psychosom

508

324

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Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.

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“…Possibly but physical assessment of the acutely mentally ill consumer is important as nearly half the texts suggested. Furthermore, as vital signs can change in response to medication, administration such as antipsychotics (Sarlon et al., 2016), the importance of measuring these signs should be highlighted in mental health nursing textbooks. Only one of the reviewed texts mentioned this (Jones & Beauvais, 2023).…”

Section: Discussionmentioning

confidence: 99%

“…Within the mental health setting, vital signs assessment might be neglected because abnormal vital sign ranges can be less clinically meaningful due to the use of psychotropic medication or because consumers' heart rate and blood pressure are often abnormal (Alvares et al., 2016; Sarlon et al., 2016). In an Australian study of 70 mental health nurses, reasons for missed nursing care also included inadequate staffing and the increased physical needs and acuity of consumers (Joseph et al., 2022).…”

Section: Introductionmentioning

confidence: 99%

Is vital signs assessment important in the acute mental health setting? A review of fundamental nursing textbooks

Elliott,

Foo

2023

Int J Mental Health Nurs

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Elevated Rest Heart Rate in Psychiatric Patients and Different Effects of Psychotropic Medication

Abstract: The elevated RHR in psychiatric patients is a common phenomenon and can be observed independently of the use of psychotropic medication but more in patients with schizophrenia. An interesting additional finding could be a possible protective effect of SSRI on RHR in psychiatric patients.

Cited by 6 publications

References 35 publications

Effects of olanzapine on resting heart rate in Japanese patients with schizophrenia

Effects of olanzapine on resting heart rate in Japanese patients with schizophrenia

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Is vital signs assessment important in the acute mental health setting? A review of fundamental nursing textbooks

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