Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders

Sutterland, Arjen L.; Blom, Marieke T.; Ladee, Katinka; Lubbers, Jorieke J.M.; Cohen, Dan; Haan, Lieuwe de; Tan, Hanno L.

doi:10.1016/j.schres.2019.06.013

Cited by 13 publications

(15 citation statements)

References 38 publications

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“…However, it was also found in 9% of the patients who were not receiving antipsychotic medication with sodium channel blocking propensity, and therefore the reported high prevalence of Brugada-type ECG in schizophrenia, and the associated risk, may not be solely attributed to the use of sodium channel-blocking antipsychotics. The increased prevalence of this ECG abnormality in schizophrenia and related conditions has recently been reported by Sutterland et al (2019), who also found a lack of association with antipsychotic use, highlighting the importance of carrying out an ECG prior to treatment (see also section on First-episode psychosis above).…”

Section: Mortality Cardiovascular Disease and Antipsychotic Treatmentmentioning

confidence: 82%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

2019

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These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment.They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.

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Section: Mortality Cardiovascular Disease and Antipsychotic Treatmentmentioning

confidence: 82%

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

2019

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“…A case control study in recent onset schizophrenia estimated the odds ratio of having an ECG suspicious for Brugada ECG pattern to be 3.5 higher in those with schizophrenia { n = 23; mean age 22 years; 90% ( n = 350) treated with antipsychotic medication} compared to healthy controls ( n = 43; mean age 20 years) [ 13 ]. Of those with Brugada suspect patterns, 22 cases had ajmaline testing, with three displaying Brugada type 1 pattern, while eight controls were tested with one displaying Brugada type 1.…”

Section: Epidemiology Of Brugada Syndrome In Schizophreniamentioning

confidence: 99%

“…SCD is generally defined as an unexpected death within one hour of the onset of symptoms, usually due to a malignant cardiac arrythmia [ 7 ]. Suggested underlying factors for SCD in schizophrenia include ischemic heart disease and QT prolongation due to antipsychotic drugs [ 8 , 9 ], decreased heart rate variability and autonomic dysfunction [ 10 ], and Brugada Syndrome (BrS) or inducible Brugada ECG patterns [ [11] , [12] , [13] ].…”

Section: Introduction: Background and Terminologymentioning

confidence: 99%

Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review

Rastogi

Viani-Walsh

Akbari

et al. 2020

General Hospital Psychiatry

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Context Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls. Methods We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD. Findings Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation. Conclusions and future directions Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.

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“…Parisi P et al presented a family study in which Brugada syndrome, which is characterized by Brugada-ECG and sudden cardiac death, and epilepsy coexist in the same family and this report indicated that familial abnormalities of the central nervous system is reflected on electrocardiograms [6]. In patients with schizophrenia, the Brugada-ECG pattern was seen more frequently [7, 8] and longer QT interval prolongation was observed [9].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, in clinical practice, many patients with schizophrenia are already on medication [7,8], and it is important to consider the effect of these drugs on electrocardiograms. Antipsychotics, mood stabilizers, and antidepressants are known to cause electrocardiogram changes such as QT prolongation and/or Brugada-ECG [17,18].…”

Section: Introductionmentioning

confidence: 99%

Early Repolarization Pattern is Associated with Schizophrenia: A Single Center Experience in Japan

Kameyama

Sugimoto

Inamura

et al. 2020

Preprint

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Introduction Recent studies have shown a high frequency of abnormal electrocardiograms in patients with schizophrenia. The objective of this study was to associate schizophrenia diagnoses with early repolarization patterns in a sample of hospitalized patients from a single hospital in Japan. Methods We conducted a retrospective age, sex and coronary risk factors matched case-control study on 85 patients with schizophrenia and 89 controls from medical checkups. First, we compared the presence of early repolarization patterns in both groups. Secondly, we elucidated an association between the presence of an early repolarization pattern and clinical findings in the patients' groups. We also evaluated J-point elevation patterns. Results As a result, we found that both early repolarization patterns and J-point elevation patterns observed were significantly higher in the schizophrenic group than in the matched control group (early repolarization pattern 23;6 P < 0.001; J-point elevation pattern 34:12; P = 0.001). After multivariable logistic regression among the patients and controls, schizophrenia was the independent predictor for early repolarization pattern (P = 0.001) and J-point elevation (P < 0.001). Among the patients, the independent predictor for early repolarization pattern was psychiatric family history (P = 0.006), while older age (P = 0.038) and psychiatric family history (P = 0.014) were predictors for J-point elevation patterns. Conclusion These findings suggest that an association between early repolarization pattern or J-point elevation pattern and schizophrenia in a single Japanese center.

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Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders

Cited by 13 publications

References 38 publications

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology

Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review

Early Repolarization Pattern is Associated with Schizophrenia: A Single Center Experience in Japan

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