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Electrocardiographic signs of autonomic imbalance in medicated patients with first-episode schizophrenia spectrum disorders – relations to first treatment discontinuation and five-year remission status

Published online by Cambridge University Press:  15 April 2020

Robert Bodén ,
Leif Lindström ,
Pentti Rautaharju  and
Johan Sundström
Robert Bodén*
Affiliation:
Department of Neuroscience Psychiatry, Uppsala University Hospital, 751 85Uppsala, Sweden
Leif Lindström
Affiliation:
Department of Neuroscience Psychiatry, Uppsala University Hospital, 751 85Uppsala, Sweden
Pentti Rautaharju
Affiliation:
Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
Johan Sundström
Affiliation:
Department of Medical Sciences, Uppsala University Hospital, 751 85Uppsala, Sweden
*
*Corresponding author. Tel.: +46 70 611 09 14; fax: +46 18 51 58 10. robert.boden@neuro.uu.se. (R. Bodén).
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Abstract

Purpose

To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status.

Subjects and methods

Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

Results

Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later.

Discussion and conclusion

In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

Keywords

ElectrocardiographyFirst-episodePsychosisRemissionAutonomic balancePrognosis
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 3 , April 2012 , pp. 213 - 218
Copyright
Copyright © Elsevier Masson SAS 2012

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References

Andreasen, N.C., Carpenter, W.T. Jr.Kane, J.M., Lasser, R.A., Marder, S.R., Weinberger, D.R.Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry. 162 3: 2005 441–449.CrossRefGoogle ScholarPubMed
Annila, P.A., Yli-Hankala, A.M., Lindgren, L.The effect of atropine on the T-wave amplitude of ECG during isoflurane anaesthesia. Int J Clin Monit Comput. 11 1: 1994 43–47.CrossRefGoogle ScholarPubMed
Bär, K.J., Berger, S., Metzner, M., Boettger, M.K., Schulz, S., Ramachandraiah, C.T.et al.Autonomic dysfunction in unaffected first-degree relatives of patients suffering from schizophrenia. Schizophr Bull. 36 5: 2010 1050–1058.CrossRefGoogle ScholarPubMed
Bär, K.J., Boettger, M.K., Schulz, S., Harzendorf, C., Agelink, M.W., Yeragani, V.K.et al.The interaction between pupil function and cardiovascular regulation in patients with acute schizophrenia. Clin Neurophysiol. 119 10: 2008 2209–2213.CrossRefGoogle ScholarPubMed
Bär, K.J., Koschke, M., Boettger, M.K., Berger, S., Kabisch, A., Sauer, H.et al.Acute psychosis leads to increased QT variability in patients suffering from schizophrenia. Schizophr Res. 95 1–3: 2007 115–123.CrossRefGoogle ScholarPubMed
Bär, K.J., Letzsch, A., Jochum, T., Wagner, G., Greiner, W., Sauer, H.Loss of efferent vagal activity in acute schizophrenia. J Psychiatr Res. 39 5: 2005 519–527.CrossRefGoogle ScholarPubMed
Bär, K.J., Wernich, K., Boettger, S., Cordes, J., Boettger, M.K., Loffler, S.et al.Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia. Psychiatry Res. 157 1–3: 2008 255–257.CrossRefGoogle Scholar
Bazett, H.An analysis of the time-relations of electrocardiograms. Heart. 1920; 7: 35–70.Google Scholar
Berlant, J.L.One more look at propranolol for the treatment of refractory schizophrenia. Schizophr Bull. 13 4: 1987 705–714.CrossRefGoogle Scholar
Blackburn, H., Keys, A., Simonson, E., Rautaharju, P., Punsar, S.The electrocardiogram in population studies. A classification system. Circulation. 1960; 21: 1160–1175.CrossRefGoogle ScholarPubMed
Bodén, R., Sundström, J., Lindström, E., Lindström, L.Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophr Res. 107 2–3: 2009 232–237.CrossRefGoogle ScholarPubMed
Castro, M.N., Vigo, D.E., Chu, E.M., Fahrer, R.D., de Achaval, D., Costanzo, E.Y.et al.Heart rate variability response to mental arithmetic stress is abnormal in first-degree relatives of individuals with schizophrenia. Schizophr Res. 109 1–3: 2009 134–140.CrossRefGoogle ScholarPubMed
Castro, M.N., Vigo, D.E., Weidema, H., Fahrer, R.D., Chu, E.M., de Achaval, D.et al.Heart rate variability response to mental arithmetic stress in patients with schizophrenia: autonomic response to stress in schizophrenia. Schizophr Res. 99 1–3: 2008 294–303.CrossRefGoogle Scholar
Choy, A.M., Lang, C.C., Roden, D.M., Robertson, D., Wood, A.J., Robertson, R.M.et al.Abnormalities of the QT interval in primary disorders of autonomic failure. Am Heart J. 136 4 Pt 1 1998 664–671.CrossRefGoogle ScholarPubMed
Dawson, M.E., Nuechterlein, K.H., Schell, A.M., Gitlin, M., Ventura, J.Autonomic abnormalities in schizophrenia. State or trait indicators?. Arch Gen Psychiatry. 51 10: 1994 813–824.CrossRefGoogle ScholarPubMed
Dinzeo, T.J., Cohen, A.S., Nienow, T.M., Docherty, N.M.Arousability in schizophrenia: relationship to emotional and physiological reactivity and symptom severity. Acta Psychiatr Scand. 117 6: 2008 432–439.CrossRefGoogle ScholarPubMed
Flyckt, L., Mattsson, M., Edman, G., Carlsson, R., Cullberg, J.Predicting 5-year outcome in first-episode psychosis: construction of a prognostic rating scale. J Clin Psychiatry. 67 6: 2006 916–924.CrossRefGoogle ScholarPubMed
Heyer, H., Winans, H., Plessinger, V.Alterations in form of the electrocardiogram in patients with mental disease. Am J Med Sci. 1947; 214: 23–27.CrossRefGoogle Scholar
Jindal, R.D., Keshavan, M.S., Eklund, K., Stevens, A., Montrose, D.M., Yeragani, V.K.Beat-to-beat heart rate and QT interval variability in first episode neuroleptic-naive psychosis. Schizophr Res. 113 2-3 2009 176–180.CrossRefGoogle ScholarPubMed
Kahn, R.S., Fleischhacker, W.W., Boter, H., Davidson, M., Vergouwe, Y., Keet, I.P.et al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 371 9618: 2008 1085–1097.CrossRefGoogle ScholarPubMed
Klein, E., Cnaani, E., Harel, T., Braun, S., Ben-Haim, S.A.Altered heart rate variability in panic disorder patients. Biol Psychiatry. 37 1: 1995 18–24.CrossRefGoogle ScholarPubMed
Koschke, M., Boettger, M.K.M.D., Schulz, S., Berger, S.M.D., Terhaar, J., Voss, A.P.et al.Autonomy of autonomic dysfunction in major depression. Psychosom Med. 71 8: 2009 852–860.CrossRefGoogle ScholarPubMed
Lampert, R., Shusterman, V., Burg, M.M., Lee, F.A., Earley, C., Goldberg, A.et al.Effects of psychologic stress on repolarization and relationship to autonomic and hemodynamic factors. J Cardiovasc Electrophysiol. 16 4: 2005 372–377.CrossRefGoogle ScholarPubMed
Lehmann, K.G., Shandling, A.H., Yusi, A.U., Froelicher, V.F.Altered ventricular repolarization in central sympathetic dysfunction associated with spinal cord injury. Am J Cardiol. 63 20: 1989 1498–1504.CrossRefGoogle ScholarPubMed
Levin, L., Trenton, N.J.Electrocardiograms of mental patients: II a further report on a total of patients. J Med Soc New Jersey. 1933; 30: 424–427.Google Scholar
Lieberman, J.A., Stroup, T.S., McEvoy, J.P., Swartz, M.S., Rosenheck, R.A., Perkins, D.O.et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 353 12: 2005 1209–1223.CrossRefGoogle ScholarPubMed
Lindström, L.H., Persson, E.Propranolol in chronic schizophrenia: a controlled study in neuroleptic-treated patients. Br J Psychiatry. 1980; 137: 126–130.CrossRefGoogle ScholarPubMed
Lo, S.S., Mathias, C.J., Sutton, M.S.QT interval and dispersion in primary autonomic failure. Heart. 75 5: 1996 498–501.CrossRefGoogle ScholarPubMed
Lovett Doust, J.W.Sinus tachycardia and abnormal cardiac rate variation in schizophrenia. Neuropsychobiology. 6 6: 1980 305–312.CrossRefGoogle Scholar
Malaspina, D., Bruder, G., Dalack, G.W., Storer, S., Van Kammen, M., Amador, X.et al.Diminished cardiac vagal tone in schizophrenia: associations to brain laterality and age of onset. Biol Psychiatry. 41 5: 1997 612–617.CrossRefGoogle ScholarPubMed
Mandic, S., Fonda, H., Dewey, F., Le, V.V., Stein, R., Wheeler, M.et al.Effect of gender on computerized electrocardiogram measurements in college athletes. Phys Sportsmed. 38 2: 2010 156–164.CrossRefGoogle ScholarPubMed
Öhman, A., Öhlund, L.S., Alm, T., Wieselgren, I.M., Öst, L.G., Lindström, L.H.Electrodermal nonresponding, premorbid adjustment, and symptomatology as predictors of long-term social functioning in schizophrenics. J Abnorm Psychol. 98 4: 1989 426–435.CrossRefGoogle ScholarPubMed
Palomba, D., Sarlo, M., Angrilli, A., Mini, A., Stegagno, L.Cardiac responses associated with affective processing of unpleasant film stimuli. Int J Psychophysiol. 36 1: 2000 45–57.CrossRefGoogle ScholarPubMed
Rautaharju, P.M., Kooperberg, C., Larson, J.C., LaCroix, A.Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women: the Women's Health Initiative. Circulation. 113 4: 2006 473–480.CrossRefGoogle ScholarPubMed
Rautaharju, P.M., Kooperberg, C., Larson, J.C., LaCroix, A.Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women: the Women's Health Initiative. Circulation. 113 4: 2006 481–489.CrossRefGoogle ScholarPubMed
Rautaharju, P.M., Nelson, J.C., Kronmal, R.A., Zhang, Z.M., Robbins, J., Gottdiener, J.S.et al.Usefulness of T-axis deviation as an independent risk indicator for incident cardiac events in older men and women free from coronary heart disease (the Cardiovascular Health Study). Am J Cardiol. 88 2: 2001 118–123.CrossRefGoogle ScholarPubMed
Rautaharju, P.M., Zhang, Z.M.Linearly scaled, rate-invariant normal limits for QT interval: eight decades of incorrect application of power functions. J Cardiovasc Electrophysiol. 13 12: 2002 1211–1218.CrossRefGoogle ScholarPubMed
Schell, A.M., Dawson, M.E., Rissling, A., Ventura, J., Subotnik, K.L., Gitlin, M.J.et al.Electrodermal predictors of functional outcome and negative symptoms in schizophrenia. Psychophysiology. 42 4: 2005 483–492.CrossRefGoogle Scholar
Szabo, A.The combined effects of orthostatic and mental stress on heart rate, T-wave amplitude, and pulse transit time. Eur J Appl Physiol Occup Physiol. 67 6: 1993 540–544.CrossRefGoogle ScholarPubMed
Taggart, P., Batchvarov, V.N., Sutton, P., Young, G., Young, S., Patterson, D.Repolarization changes induced by mental stress in normal subjects and patients with coronary artery disease: effect of nitroglycerine. Psychosom Med. 71 1: 2009 23–29.CrossRefGoogle ScholarPubMed
Toichi, M., Kubota, Y., Murai, T., Kamio, Y., Sakihama, M., Toriuchi, T.et al.The influence of psychotic states on the autonomic nervous system in schizophrenia. Int J Psychophysiol. 31 2: 1999 147–154.CrossRefGoogle Scholar
Wieselgren, I.M., Öhlund, L.S., Lindström, L.H., Öhman, A.Electrodermal activity as a predictor of social functioning in female schizophrenics. J Abnorm Psychol. 103 3: 1994 570–575.CrossRefGoogle ScholarPubMed
Zahn, T.P., Carpenter, W.T. Jr.McGlashan, T.H.Autonomic nervous system activity in acute schizophrenia: I. method and comparison with normal controls. Arch Gen Psychiatry. 38 3: 1981 251–258.CrossRefGoogle ScholarPubMed
Zahn, T.P., Carpenter, W.T. Jr.McGlashan, T.H.Autonomic nervous system activity in acute schizophrenia: II. Relationships to short-term prognosis and clinical state. Arch Gen Psychiatry. 38 3: 1981 260–266.CrossRefGoogle ScholarPubMed
Zahn, T.P., Pickar, D.Autonomic activity in relation to symptom ratings and reaction time in unmedicated patients with schizophrenia. Schizophr Res. 79 2–3: 2005 257–270.CrossRefGoogle ScholarPubMed
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