Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review.
Antipsychotics
Brugada ECG pattern
Clozapine
Implantable cardioverter defibrillator
Long QT syndrome
Psychosis
Sudden cardiac death
Journal
General hospital psychiatry
ISSN: 1873-7714
Titre abrégé: Gen Hosp Psychiatry
Pays: United States
ID NLM: 7905527
Informations de publication
Date de publication:
Historique:
received:
16
05
2020
revised:
28
08
2020
accepted:
28
09
2020
pubmed:
17
10
2020
medline:
26
11
2021
entrez:
16
10
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 33065406
pii: S0163-8343(20)30138-9
doi: 10.1016/j.genhosppsych.2020.09.003
pmc: PMC7537626
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
83-91Informations de copyright
Copyright © 2020. Published by Elsevier Inc.
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