Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia

Bär, Karl‐Jürgen; Wernich, Kirsten; Boettger, Silke; Cordes, Joachim; Boettger, Michael Karl; Löffler, Stefan; Kornischka, Jürgen; Agelink, M.W.

doi:10.1016/j.psychres.2007.04.021

Cited by 71 publications

(66 citation statements)

References 15 publications

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“…Autonomic dysregulation may also explain the association between BrS and schizophrenia, being reported in both conditions. However, although reduced vagal tone exists in patients with schizophrenia (including those not using antipsychotics), 35 the increased vagal tone may unmask Brugada-ECG and cause SCD in BrS.…”

Section: Schizophrenia and Brugada-ecgmentioning

confidence: 99%

Brugada Syndrome ECG Is Highly Prevalent in Schizophrenia

Blom

Cohen

Seldenrijk

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background— The causes of increased risk of sudden cardiac death in schizophrenia are not resolved. We aimed to establish (1) whether ECG markers of sudden cardiac death risk, in particular Brugada-ECG pattern, are more prevalent among patients with schizophrenia, and (2) whether increased prevalence of these ECG markers in schizophrenia is explained by confounding factors, notably sodium channel–blocking medication. Methods and Results— In a cross-sectional study, we analyzed ECGs of a cohort of 275 patients with schizophrenia, along with medication use. We determined whether Brugada-ECG was present and assessed standard ECG measures (heart rate, PQ-, QRS-, and QT-intervals). We compared the findings with nonschizophrenic individuals of comparable age (the Netherlands Study of Depression and Anxiety [NESDA] cohort; N=179) and, to account for assumed increased aging rate in schizophrenia, with individuals 20 years older (Hoorn cohort; n=1168), using multivariate regression models. Brugada-ECG was significantly more prevalent in the schizophrenia cohort (11.6%) compared with NESDA controls (1.1%) or Hoorn controls (2.4%). Moreover, patients with schizophrenia had longer QT-intervals (410.9 versus 393.1 and 401.9 ms; both P <0.05), increased proportion of mild or severe QTc prolongation (13.1% and 5.8% versus 3.4% and 0.0% [NESDA], versus 5.1 and 2.8% [Hoorn]), and higher heart rates (80.8 versus 61.7 and 68.0 beats per minute; both P <0.05). The prevalence of Brugada-ECG was still increased (9.6%) when patients with schizophrenia without sodium channel–blocking medication were compared with either of the control cohorts. Conclusions— Brugada-ECG has increased prevalence among patients with schizophrenia. This association is not explained by the use of sodium channel–blocking medication.

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Section: Schizophrenia and Brugada-ecgmentioning

confidence: 99%

Brugada Syndrome ECG Is Highly Prevalent in Schizophrenia

Blom

Cohen

Seldenrijk

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…There is extensive evidence suggesting that reduced HRV was associated with serious psychiatric illness, such as bipolar disorder and schizophrenia (Bär et al, 2009;Castro et al, 2008). Severity of psychotic symptoms of schizophrenia was associated with cardiac autonomic disturbance (Bär et al, 2008). Taken together, low HRV may be a predisposing factor that leads to dysfunctional neural processing of visual stimuli, which may eventually lead to the development of psychiatric illness, such as schizophrenia (Park et al, 2012b;Thayer & Lane, 2009).…”

Section: Discussionmentioning

confidence: 99%

Individual differences in cardiac vagal tone are associated with differential neural responses to facial expressions at different spatial frequencies: An ERP and sLORETA study

Park¹,

Moon²,

Kim

et al. 2012

Cogn Affect Behav Neurosci

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A previous study has shown that greater cardiac vagal tone, reflecting effective self-regulatory capacity, was correlated with superior visual discrimination of fearful faces at high spatial frequency Park et al. (Biological Psychology 90:171-178, 2012b). The present study investigated whether individual differences in cardiac vagal tone (indexed by heart rate variability) were associated with different event-related brain potentials (ERPs) in response to fearful and neutral faces. Thirty-six healthy participants discriminated the emotion of fearful and neutral faces at broad, high, and low spatial frequencies, while ERPs were recorded. Participants with low resting heart rate variability-characterized by poor functioning of regulatory systems-exhibited significantly greater N200 activity in response to fearful faces at low spatial frequency and greater LPP responses to neutral faces at high spatial frequency. Source analyses-estimated by standardized low-resolution brain electromagnetic tomography (sLORETA)-tended to show that participants with low resting heart rate variability exhibited increased source activity in visual areas, such as the cuneus and the middle occipital gyrus, as compared with participants with high resting heart rate variability. The hyperactive neural activity associated with low cardiac vagal tone may account for hypervigilant response patterns and emotional dysregulation, which heightens the risk of developing physical and emotional problems.

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“…It remains unclear whether HRV may provide an important marker for social functioning or other symptom severity measures . For example, while Bär et al (2008b) reported a significant negative association between HRV and symptom severity in a sample of participants with paranoid schizophrenia, other research has failed to find such an association (Jindal et al, 2009). …”

Section: Introductionmentioning

confidence: 98%

“…The relationship between schizophrenia and cardiovascular-related mortality may be mediated by reduced autonomic cardiac control (Bär et al, 2008b), which can be indexed non-invasively via the measurement of heart rate variability (HRV). HRV is defined as the fluctuation of heart period over time, commonly measured by electrocardiogram via the identification of variations between interbeat intervals.…”

Section: Introductionmentioning

confidence: 99%

“…The cardiovascular impact of neuroleptics is of large clinical importance given reported associations with ventricular arrhythmias and sudden cardiac death (Agelink et al, 2001;Ray et al, 2009). While some studies have shown that tricyclic antidepressants (TCA) (for example, amitriptyline, doxepine, imipramine) and neuroleptics such as clozapine strongly reduce HRV (Agelink et al, 2001;Bär et al, 2008b;Rechlin et al, 1994a;Zahn and Pickar, 1993) due to their anticholinergic properties (Jakobsen et al, 1984;Rechlin et al, 1994b), other studies report no significant negative effects of neuroleptics on HRV (Bär et al, 2005;Chang et al, 2010;Malaspina et al, 2002). There appears to be more agreement however regarding the lack of a parasympathetic effect associated with selective serotonin reuptake inhibitors (SSRIs) (Kemp et al, 2010;Rechlin et al, 1994b).…”

Section: Introductionmentioning

confidence: 99%

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Reduced heart rate variability in a treatment-seeking early psychosis sample

Cacciotti-Saija¹,

Quintana²,

Alvares³

et al. 2017

Preprint

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Reduced cardiac autonomic function is associated with increased risk of cardiovascular disease (CVD), with heart rate variability (HRV) providing an accessible index of cardiac autonomic function. HRV may provide a candidate physiological mechanism linking reduced cardiac autonomic function to increased risk for CVD in schizophrenia illness. This study examines whether HRV is also reduced in a community sample of treatment-seeking participants experiencing early psychosis (n = 48) compared to healthy volunteers (n = 48) and social anxiety control groups (n= 48) matched by gender and age. HRV was assessed during a five-minute interbeat interval recording at rest. Participants also completed self-report psychiatric symptom measures. Early psychosis participants demonstrated significant reductions in HRV compared to control groups but not compared to medication free healthy controls.Reductions in HRV were also observed in early psychosis participants taking anticholinergic medications compared to both control groups taking cardio-benign medications or who were non-medicated. Lastly, whether or not early psychosis participants were taking anticholinergic medications did not significantly impact reductions in HRV. Findings provide preliminary evidence that early psychosis is associated with reduced HRV. Treatment implications include the importance of early screening and targeting modifiable risk factors associated with CVD to attenuate risk.

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Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia

Cited by 71 publications

References 15 publications

Brugada Syndrome ECG Is Highly Prevalent in Schizophrenia

Brugada Syndrome ECG Is Highly Prevalent in Schizophrenia

Individual differences in cardiac vagal tone are associated with differential neural responses to facial expressions at different spatial frequencies: An ERP and sLORETA study

Reduced heart rate variability in a treatment-seeking early psychosis sample

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