Heart Rate Variability in Schizophrenic Patients Switched from Typical Antipsychotic Agents to Amisulpride and Olanzapine

Abstract

Schizophrenia is a severe mental disorder that requires lifelong treatment, and therefore information on the cardiovascular safety and tolerance of antipsychotics is of significant clinical importance. Atypical antipsychotics have been used to treat schizophrenia patients since the 1990s, and more and more patients have been switched to these from typical antipsychotics; however, there is still no accessible evaluation tool for assessing cardiovascular safety. In this study, we used a computer-assisted 5-min measurement of resting heart rate variability (HRV) in schizophrenia patients who were switched to atypical antipsychotic agents (amisulpride and olanzapine) due to severe side effects (tardive dyskinesia). In 15 patients who switched to amisulpride and 18 to olanzapine, HRV was evaluated before the medication was switched, and patients were followed up every month for 3 months after the switch. Frequency-domain analyses of short-term and stationary respiratory rate (RR) intervals were performed to evaluate low-frequency power (LF; 0.04–0.15 Hz), high-frequency power (HF; 0.15–0.40 Hz), the ratio of LF to HF (LF/HF), and LF in normalized units (LF%). Our results showed significant increases in the mean, variance and HF of RR intervals in the amisulpride group, but not in the olanzapine group. These results indicate that amisulpride has a more vagotonic effect, suggesting greater cardiovascular safety as compared with olanzapine when subjects are switched from typical antipsychotic agents.

Impact of Antipsychotics and Anticholinergics on Autonomic Modulation in Patients With Schizophrenia

“…Previous studies have revealed that clozapine has an inhibitory effect on HRV, 30,32 whereas amisulpiride produces a higher HF than olanzapine after switching from a typical antipsychotics. 41 Our results are compatible with these studies and go further by pointing out that other antipsychotics with an HMA (or so-called dirty drugs) also have an effect of parasympathetic inhibition. Among these antipsychotics, the muscarinic affinity is much higher than the nicotinic affinity.…”

Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

“…Duplicates were removed, titles and abstracts scanned, potential articles read and evaluated against inclusion criteria and authors contacted for additional data when necessary. In total, 140 case-control and 30 treatment 76,83,93,110,116,129,138,141,155,175,[187][188][189][190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206] studies were eligible for inclusion in the quantitative synthesis (151 case-control and 43 effect sizes for analysis); 10 of the studies were included in both the case-control and treatment analyses. 76,83,93,110,116,129,138,141,155,175 Four subgroups of disorders (mood, anxiety-related, psychotic and substance dependence disorders) and 2 classes of psychotropic medications (antidepressants and antipsychotics) were included.…”

Heart rate variability and vagal tone in schizophrenia: A review

“…Further, Mathewson et al (2012) found that clozapine-treated patients displayed both poorer performance on the WCST and lower levels of parasympathetic activity relative to schizophrenia patients treated with other antipsychotic medications. Similarly, Wang et al (2008) examined schizophrenia patients who were switched from typical antipsychotic medication to either amisulpride or olanzapine. Parasympathetic activity improvements were observed in patients who were transitioned to amisulpride versus olanzapine.…”