Kardiale Komplikationen bei Patienten mit schizophrenen Störungen

Abstract

It is well known, that patients with schizophrenia exhibit increased rates of cardiac morbidity and mortality. Frequent cardiovascular diseases are only partially explained by lifestyle, inactivity, dietary habits and nicotine abuse, but also by reduced compliance in prevention programs. On the other hand, it has been shown that particularly atypical antipsychotic agents are differentially responsible for high rates of obesity, hypertriglyceridemia, and diabetes. Therefore, a standardized evaluation of corresponding parameters is indicated in every patient. If needed, modulation of the medication regimen has to be performed. Additionally, a dietary counselling of the patient and his family should be offered. Besides pharmacological approaches to normalize dyslipidemia, specific behavioural therapy programmes are an option that may alter metabolic parameters. Threatening cardiac complications in long-term treatment of schizophrenia may also be the result of direct side effects under treatment with antipsychotics, like QT-prolongation triggering major arrhythmias. For prevention, predisposing risk factors like electrolyte disturbances, pre-existing cardiac diseases, co-medication with QT prolonging drugs and medication with potential cytochrome P450 interaction have to be taken into consideration.

Psychosomatik und Psychotherapie der koronaren Herzerkrankung

“…Dabei spielen neben den bereits bekannten Ursachen wie ungesunder Lebensstil, Stress, sozialer Isolation auch Nebenwirkungen von Neuroleptika eine Rolle. Die kardiotoxische Wirkung geht dabei vom ungünstigen Einfluss auf das Körpergewicht und den Fettstoffwechsel aus sowie von direkten kardialen Nebenwirkungen in Form der Induktion von Arrhythmien durch die Verlängerung der QT-Zeit 28 . Regelmäßige Kontrolluntersuchungen (Labor, Gewicht, EKG) in Abhängigkeit vom individuellen Risiko sind angebracht.…”