본문 바로가기
KERD
논문KCI 등재

만성 조현병 입원환자에서의 QTc 간격 연장과 관련된 요인

The Factors in Relation with Prolonged QTc Intervals in Chronic Schizophrenia Inpatients

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류정신과학

초록

Objectives:QTc prolongation is associated with fatal arrhythmias, particularly torsades de pointes and sudden cardiac death. However, little is known regarding the risk factors for QTc prolongation in in-patients with chronic schizophrenia who take antipsychotics. This study aimed to explore the association between QTc and demographic variables, metabolic parameters and prescribed medications in-patients with chronic schizophrenia who take antipsychotics. Methods:We examined 200 in-patients with chronic schizophrenia who were taking antipsychotics in a long-term psychiatric hospital. Demographic and clinical variables, including ECG and prescribed medications, were retrospectively obtained from medical charts. QTc prolongation was defined as increased QTc intervals greater than 450ms in men and 470ms in women. The associations between QTc and other continuous variables were assessed using correlation and regression analyses, and a secondary analysis of interaction effects was performed among significant variables. Results:The prevalence of QTc prolongation inpatients with schizophrenia was 33.1%. After controlling for significant variables, linear regression analysis revealed that QT interval was influenced by a total antipsychotic dose(β= 0.19, p<0.01). There was a significant interaction effect between total antipsychotics dose and cigarette smoking with QTc as the dependent variable(β=-0.36, p<0.01). Conclusion:The total antipsychotics dose is associated with QTc prolongation in a dose-related manner. It is important for psychiatrists to consider various factors when prescribing antipsychotics and to regularly check patients’ ECG.

Abstract

Objectives:QTc prolongation is associated with fatal arrhythmias, particularly torsades de pointes and sudden cardiac death. However, little is known regarding the risk factors for QTc prolongation in in-patients with chronic schizophrenia who take antipsychotics. This study aimed to explore the association between QTc and demographic variables, metabolic parameters and prescribed medications in-patients with chronic schizophrenia who take antipsychotics. Methods:We examined 200 in-patients with chronic schizophrenia who were taking antipsychotics in a long-term psychiatric hospital. Demographic and clinical variables, including ECG and prescribed medications, were retrospectively obtained from medical charts. QTc prolongation was defined as increased QTc intervals greater than 450ms in men and 470ms in women. The associations between QTc and other continuous variables were assessed using correlation and regression analyses, and a secondary analysis of interaction effects was performed among significant variables. Results:The prevalence of QTc prolongation inpatients with schizophrenia was 33.1%. After controlling for significant variables, linear regression analysis revealed that QT interval was influenced by a total antipsychotic dose(β= 0.19, p<0.01). There was a significant interaction effect between total antipsychotics dose and cigarette smoking with QTc as the dependent variable(β=-0.36, p<0.01). Conclusion:The total antipsychotics dose is associated with QTc prolongation in a dose-related manner. It is important for psychiatrists to consider various factors when prescribing antipsychotics and to regularly check patients’ ECG.

참고문헌 (40)

  1. Koponen H, "Schizophrenia and sudden cardiac death", Nordic J Psychiatry, 62, pp.342~345 (2008)[DOI]
  2. Faber TS, "Drug-induced torsade de pointes", Drug Safety, 11, pp.463~466 (1994)[DOI]
  3. Algra A, "QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest", Circulation, 83(6), pp.1888~1894 (1991)[DOI]
  4. Fayssoil A, "Torsade de pointes induced by citalopram and amiodarone", Annales de Cardiologie et D'angeiologie, 60, pp.165~168 (2011)[DOI]
  5. Moss AJ, "Measurement of the QT interval and the risk associated with QTc interval prolongation: a review", Am J Cardiol, 72, pp.23~25 (1993)[DOI]
  6. Glassman AH, "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death", Am J Psychiatry, 158, pp.1774~1782 (2001)[DOI]
  7. Shader RI, "Potassium, antipsychotic agents, arrhythmias, and sudden death", J Clin Psychopharmacology, 18, pp.427~428 (1998)[DOI]
  8. Beach SR, "QTc prolongation, torsades de pointes, and psychotropic medications", Psychosomatics, 54, pp.1~13 (2013)[DOI]
  9. Roden DM, "Drug-induced prolongation of the QT interval", N Engl J Med, 350, pp.1013~1022 (2004)[DOI]
  10. Zemrak WR, "Association of antipsychotic and antidepressant drugs with QT interval prolongation", Am J Health-System Pharm, 65, pp.1029~1038 (2008)[DOI]
  11. Chong SA, "Prolonged QTc intervals in medicated patients with schizophrenia", Hum Psychopharmacol, 18, pp.647~649 (2003)[DOI]
  12. Information for healthcare professionals: haloperidol, "US Food and Drug Administration", Center for drug evaluation and research, ~ (2007)
  13. Harrigan EP, "A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition", J Clin Psychopharmacol, 24, pp.62~69 (2004)[DOI]
  14. Isbister GK, "Amisulpride deliberate self-poisoning causing severe cardiac toxicity including QT prolongation and torsades de pointes", Med J Aust, 184, pp.354~ (2006)
  15. Gallego JA, "Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009", Schizophr Res, 138, pp.18~28 (2012)[DOI]
  16. Michelsen JW, "Cardiovascular effects of antipsychotics", Expert Rev Neurother, 7, pp.829~839 (2007)[DOI]
  17. Barbui C, "Antipsychotic dose mediates the association between polypharmacy and corrected QT interval", PloS one, 11, pp.e0148212~ (2016)[DOI]
  18. Takeuchi H, "Antipsychotic polypharmacy and corrected QT interval: a systematic review", Can J Psychiatry, 60, pp.215~222 (2015)[DOI]
  19. Ramos-Rios R, "QTc interval in a sample of long-term schizophrenia inpatients", Schizophr Res, 116, pp.35~43 (2010)[DOI]
  20. Reilly JG, "QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients", Lancet, 355, pp.1048~1052 (2000)[DOI]
  21. American Psychiatric Association, "Diagnostic and statistical manual of mental disorders(DSM-5(R))" (2013), American psychiatric pub
  22. 양병화, "다변량 데이터 분석법의 이해", pp.64~ (2006), 커뮤니케이션북스
  23. Woods SW, "Chlorpromazine equivalent doses for the newer atypical antipsychotics", J Clin Psychiatry, 64, pp.663~667 (2003)[DOI]
  24. Sweileh WM, "Evaluation of defined daily dose, percentage of british national formulary maximum and chlorpromazine equivalents in antipsychotic drug utilization", Saudi Pharm J, 22, pp.127~132 (2014)[DOI]
  25. Rey MJ, "Guideline for the dosage of neuroleptics. I: chlorpromazine equivalents of orally administered neuroleptics", Int Clin Psychopharmacol, 4, pp.95~104 (1989)[DOI]
  26. Aiken LS, "Multiple regression: Testing and interpreting interactions" (1991), Sage
  27. Ozeki Y, "Risk factors of QT interval prolongation in japanese patients with schizophrenia", Inter J Neuropsychopharm, 11, pp.149~ (2008)
  28. Katharina W, "QTc prolongation by psychotropic drugs and the risk of torsade de pointes", Dtsch Arztebl Int, 108(41), pp.687~ (2011)
  29. Haddad PM, "Antipsychotic-related QTc prolongation, torsade de pointes and sudden death", Drugs, 62, pp.1649~1671 (2002)[DOI]
  30. 박민경, "조현병 환자에서 QT 간격 지연과 흡연의 연관성", 생물치료정신의학, 18(2), pp.238~245 (2012), 대한생물치료정신의학회
  31. Bahaoddini A, "Genetic polymorphism of glutathione S-transferase T1(GSTT1) and QT-interval in schizophrenia patients", J Mol Neurosci, 38, pp.173~ (2009)[DOI]
  32. Okayasu H, "Pharmacotherapeutic determinants for QTc interval prolongation in Japanese patients with mood disorder", Pharmacopsychiatry, 45, pp.79~83 (2012)[DOI]
  33. Lohr JB, "Smoking and schizophrenia", Schizophr Res, 8, pp.93~102 (1992)[DOI]
  34. Desai HD, "Smoking in patients receiving psychotropic medications", CNS Drugs, 15, pp.469~494 (2001)[DOI]
  35. Arslan E, "Effect of uncomplicated obesity on QT interval in young men", Pol Arch Med Wewn, 120, pp.209~213 (2010)
  36. Huikuri HV, "Sudden death due to cardiac arrhythmias", N Engl J Med, 346, pp.946~947 (2002)[DOI]
  37. Faramawi MF, "The association of the metabolic syndrome with QTc interval in NHANES III", Eur J Epidemiol, 23, pp.459~ (2008)[DOI]
  38. Wirshing DA, "Schizophrenia and obesity: impact of antipsychotic medications", J Clin Psychiatry, 65, pp.13~26 (2003)
  39. Wenzel-Seifert K, "QTc prolongation by psychotropic drugs and the risk of torsade de pointes", Dtsch Arztebl Int, 108, pp.687~693 (2011)
  40. Wolf ME, "Lithium therapy, hypercalcemia, and hyperparathyroidism", Am J Ther, 4, pp.323~326 (1997)[DOI]

관련 논문AI추천

이 간행물의 다른 논문 (6건)