Abstract
The majority of excess mortality among people with schizophrenia seems to be caused by cardiovascular complications, and in particular, coronary heart disease. In addition, the prevalence of heart failure and arrhythmias is increased in this population. Reduced efferent vagal activity, which has been consistently described in these patients and their healthy first-degree relatives, might be one important mechanism contributing to their increased cardiac mortality. A decrease in heart rate variability and complexity was often shown in unmedicated patients when compared to healthy controls. In addition, faster breathing rates, accompanied by shallow breathing, seem to influence autonomic cardiac functioning in acute unmedicated patients substantially. Moreover, low-physical fitness is a further and independent cardiac risk factor present in this patient population. Interestingly, new studies describe chronotropic incompetence during physical exercise as an important additional risk factor in patients with schizophrenia. Some studies report a correlation of the autonomic imbalance with the degree of positive symptoms (i.e., delusions) and some with the duration of disease. The main body of psychiatric research is focused on mental aspects of the disease, thereby neglecting obvious physical health needs of these patients. Here, a joint effort is needed to design interventional strategies in everyday clinical settings to improve physical health and quality of life.
Highlights
A large body of evidence has documented shortened life expectancy in patients with schizophrenia [1,2,3,4]
It has been assumed that suicides, accidents, and cardiovascular disorders are the main reasons for the excess of premature and sudden deaths among patients with schizophrenia [3,4,5,6]
In patients treated with antipsychotics, research showed evidence that the incidence-rate ratio of sudden cardiac death (SCD) was doubled in individuals receiving first- or second-generation antipsychotics in the last month of life [7]
Summary
A large body of evidence has documented shortened life expectancy in patients with schizophrenia [1,2,3,4]. The dose-dependent effect of antipsychotics on myocardial cell repolarization was assumed to lead to torsades de pointes, arrhythmias, and, to ventricular fibrillation and SCD. In this line of evidence, a recent study reporting autopsy findings in inpatients with schizophrenia showed that cardiovascular disorders were the most common cause of death [8]. In addition to coronary artery disease or diseases of the myocardium, cardiac electrophysiological abnormalities might predispose to the development of ventricular fibrillation This is especially important after acute myocardial infarction (AMI). Physicians found that various indices of heart rate variability (HRV) are of predictive value for the outcome of patients after AMI These measures were transferred to other patient populations. The definite influence of profound autonomic dysfunction in patients with schizophrenia for reduced life expectancy needs to be shown in long-term prospective studies
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