![]() We obtained the following information from the hospital records of each patient: age, medical history, status during hospital admission before antipsychotic use (e.g., reason for admission), actual administration and given dose of antipsychotics, and the use of other QT prolonging drugs (Arizona CERT (, a reference standard for clinicians)). All measurements were analyzed for each patient, based on the best readable recording. QT and QTc durations were measured by hand and corrected for heart rate using Bazett's formula (QTc). The institutional medical ethics committee waived the need for an informed consent at the time of hospitalization for the collection of data in the hospital databases both for clinical and for research purposes. No clinical trials or experimental designs were utilized. All data were retrieved from the hospital's databases (where data of routine clinical care measures were stored) and analyzed anonymously. The chart review was conducted according to the principles expressed in the Declaration of Helsinki. QT and QTc were compared considering the atypical neuroleptics administered. We collected information from the chart reviews of all patients of whom at least one ECG recording was made during antipsychotic prescription. Twelve patients (12/184 6.5%) were treated with a second atypical antipsychotic as add-on to the first one. Sixty-three patients (63/184 34.2%) were treated with other drugs, namely, mood stabilizers, benzodiazepines (BDZs), or typical antipsychotics. Patients who were treated with one atypical antipsychotic were 109/184 (59.2%). The chart review was conducted on a total of 184 male patients hospitalized between 20 at the Psychiatric Clinic of the University of Pisa, Italy. In this paper, we aimed at examining whether there was an association between antipsychotic use and QT/QTc duration in a common population of hospitalized male patients with Psychotic Disorders, by collecting the ECG during atypical antipsychotic use. Conversely, hypokalemia could be frequent, because of nausea and vomiting, alcohol abuse, or severe agitation. The inherited long QT syndrome is infrequent (1/5000 subjects) and it is due to a genetic defect of cardiac ion channels that might predispose the subject to torsade de pointes. Moreover, two risk factors unrelated to pharmacotherapy, namely, low potassium levels and inherited long QT syndrome could potentially lead to arrhythmias or torsade de pointes, especially when combined with the cardiovascular effects of antipsychotics. Although these drugs are all antipsychotics, they had different side effect profiles, receptor affinities, and mechanisms of action, thus emphasizing the difficulties in making generalizations about them. The introduction of ziprasidone was delayed in the US because of concerns about QTc lengthening. Sertindole was never marketed in the US mesoridazine was marketed in the US but with a warning regarding dose-related QTc prolongation and associated risk of torsade de pointes. Ī number of antipsychotics have led to concern about QT changes. Moreover, patients whose QTc has increased by 60 msec during antipsychotic treatment would also need to be monitored closely. If a patient has a borderline QTc, he/she should be assessed at baseline and intermittently after initiation when prescribing any antipsychotic. ![]() Normal QTc interval is 450 msec for males and >470 msec for females. ![]() ![]() Reference points for normal, borderline, and prolonged QTc are well known. Since this interval depends on heart rate, it is usually measured and reported as the corrected QT interval (QTc). The QT interval is the time during which the system repolarizes. The electrical action of the heart has two components: depolarization, or the stage before the peak of the cardiac wave that leads to the contraction of the heart muscle, and repolarization, the stage in which the heart recharges for the next beat and the heart muscle relaxes. However, one of the most relevant cardiovascular side effects of antipsychotics is QT prolongation. For example, the α1 adrenergic blockade can raise the risk of syncope or hypotension with an increased incidence of angina episodes. Several physiologic cardiovascular effects are associated with the action mechanism of antipsychotics. The prevalence of cardiovascular diseases is high in patients with Psychotic Disorders for a number of reasons, including continued antipsychotic therapy, especially combined therapy with more than one antipsychotic or with other agents. ![]()
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