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Case report
peer-reviewed

Influence of Acute Antipsychotic Treatment on Cardiorespiratory Coupling and Heart Rate Variability



Abstract

A major contributing factor associated with increased cardiac mortality in patients with schizophrenia (SCZ) seems to be a dysfunction of the autonomic nervous system (ANS). The link between ANS dysfunction and SCZ is multifactorial, but some reports suggest that the use of antipsychotics could be implicated. This case illustrates the time course of autonomic improvement in response to antipsychotic treatment in an inpatient with SCZ in acute psychosis. To this end, we documented markers of autonomic function during hospitalization. Heart rate variability (HRV; cardiac autonomic modulation) analysis showed an increased variability over time (from Day 1 to Day 3), with strongest reaction at Day 3. The respiration analysis showed an increased respiratory variability over time (from Day 1 to Day 3) suggesting improved autonomic modulation in response to the pharmacotherapy. Cardiorespiratory coupling (CRC; surrogate of cardiorespiratory synchrony and cardiovagal modulation) showed an increasing influence of heart rate on respiration and increased from Day 1 to Day 3. The concurrent improvement of psychosis and autonomic function in response to antipsychotic treatment in this patient suggest a potential cardio protective role of antipsychotics in the acute setting. Prospective trials aimed at examining the cardiovascular implications of acute psychosis treatment in patients with schizophrenia are warranted.



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Case report
peer-reviewed

Influence of Acute Antipsychotic Treatment on Cardiorespiratory Coupling and Heart Rate Variability


Author Information

Roboam R. Aguirre Corresponding Author

Division of Clinical and Translational Research, Larkin Community Hospital

Mixel Z. Mustafa

Department of Psychiatry, Larkin Community Hospital

Alessandra Dumenigo

Division of Clinical & Translational Research, Larkin Community Hospital

Steffen Schulz

Institute of Innovative Health Technologies, University of Applied Sciences Jena, Jena, Germany

Andreas Voss

Institute of Innovative Health Technologies, University of Applied Sciences Jena, Jena, Germany

Bishoy Goubran

Division of Clinical and Translational Research, Larkin Community Hospital

Rhaisa Dumenigo

Department of Psychiatry, Larkin Community Hospital

Marcos A. Sanchez-Gonzalez

Division of Clinical & Translational Research, Larkin Community Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. N/A issued approval N/A. This is a case report; informed consent was obtained from the patient. Patient information was de-identified. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Influence of Acute Antipsychotic Treatment on Cardiorespiratory Coupling and Heart Rate Variability


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Case report
peer-reviewed

Influence of Acute Antipsychotic Treatment on Cardiorespiratory Coupling and Heart Rate Variability

  • Author Information
    Roboam R. Aguirre Corresponding Author

    Division of Clinical and Translational Research, Larkin Community Hospital

    Mixel Z. Mustafa

    Department of Psychiatry, Larkin Community Hospital

    Alessandra Dumenigo

    Division of Clinical & Translational Research, Larkin Community Hospital

    Steffen Schulz

    Institute of Innovative Health Technologies, University of Applied Sciences Jena, Jena, Germany

    Andreas Voss

    Institute of Innovative Health Technologies, University of Applied Sciences Jena, Jena, Germany

    Bishoy Goubran

    Division of Clinical and Translational Research, Larkin Community Hospital

    Rhaisa Dumenigo

    Department of Psychiatry, Larkin Community Hospital

    Marcos A. Sanchez-Gonzalez

    Division of Clinical & Translational Research, Larkin Community Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. N/A issued approval N/A. This is a case report; informed consent was obtained from the patient. Patient information was de-identified. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 15, 2018

    DOI

    10.7759/cureus.2066

    Cite this article as:

    Aguirre R R, Mustafa M Z, Dumenigo A, et al. (January 15, 2018) Influence of Acute Antipsychotic Treatment on Cardiorespiratory Coupling and Heart Rate Variability. Cureus 10(1): e2066. doi:10.7759/cureus.2066

    Publication history

    Received by Cureus: November 22, 2017
    Peer review began: December 11, 2017
    Peer review concluded: January 04, 2018
    Published: January 15, 2018

    Copyright

    © Copyright 2018
    Aguirre et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A major contributing factor associated with increased cardiac mortality in patients with schizophrenia (SCZ) seems to be a dysfunction of the autonomic nervous system (ANS). The link between ANS dysfunction and SCZ is multifactorial, but some reports suggest that the use of antipsychotics could be implicated. This case illustrates the time course of autonomic improvement in response to antipsychotic treatment in an inpatient with SCZ in acute psychosis. To this end, we documented markers of autonomic function during hospitalization. Heart rate variability (HRV; cardiac autonomic modulation) analysis showed an increased variability over time (from Day 1 to Day 3), with strongest reaction at Day 3. The respiration analysis showed an increased respiratory variability over time (from Day 1 to Day 3) suggesting improved autonomic modulation in response to the pharmacotherapy. Cardiorespiratory coupling (CRC; surrogate of cardiorespiratory synchrony and cardiovagal modulation) showed an increasing influence of heart rate on respiration and increased from Day 1 to Day 3. The concurrent improvement of psychosis and autonomic function in response to antipsychotic treatment in this patient suggest a potential cardio protective role of antipsychotics in the acute setting. Prospective trials aimed at examining the cardiovascular implications of acute psychosis treatment in patients with schizophrenia are warranted.



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