P.841QTc changes in the management of SARS-CoV-2 infection in patents schizophrenia spectrum disorders

Abstract

Background: Hydroxychloroquine (HCQ) has been one of the most recommended treatment strategies since the Covid19 outbreak was announced. Although the efficiency of the HCQ is controversial, adverse effects such as QTc prolongation is still considered to be major concern due to causing potential life-threatening cardiac rhythm problem. More specifically, concurrent use of HCQ with antipsychotics which known to be a potential risk factor for QTc prolongation another important issue that needs to be addressed. The aim of the present study is to explore the potential QTc prolongation side effect of HCQ when used concurrently with antipsychotics in patients diagnosed with schizophrenia spectrum disorders and covid19 infection. Method(s): We conducted a retrospective file analysis study in patients followed up inpatient psychiatric unit for Covid19 schizophrenia patients. 25 schizophrenia patients with covid19 infection electrocardiographic data were analyzed retrospectively during the follow-up period. Before initiation of the HCQ treatment, during and after the HCQ treatment, all the electrocardiographic data were analyzed a daily basis. Electrocardiographic measurements were made on the day before HCQ treatment, during the 5-day treatment period and for 7 days after treatment cessation. QTc intervals of 470 ms (females) and 450 ms (males) were considered borderline, longer QTc intervals were considered pathological. More than 500 ms prolongation in the QTc interval was considered to be a life-threatening situation. The current antipsychotic dose was applied by 50% less to prevent Qtc prolongation before the start of COVID 19 treatment, during the 5-day treatment period and for 7 days following treatment discontinuation. Result(s): According to the data analysis, QTc intervals were found to be exceeding the borderline limit between the day of 3rd and 5th of the HCQ treatment and on the first day of HCQ discontinuation compare to before HCQ (p values< 0.05). Since the borderline limits of prolongation in the QT interval are different in men and women, these two groups were evaluated separately at the next stage. While the borderline limit is 470 millisecond for women and 450 milliseconds for men, HCQ treatment just showed a significant difference on the day of the 2nd and 3rd days of the treatment period compared to before HCQ (p values<0.05). Accordingly, the difference in the QT duration according to the initial values reaches statistical significance only in women and on the 2nd and 3rd days of HCQ treatment (p values <0.05). When the data is analyzed individually, it is observed that the cases that exceed the borderline from time to time do not have a common feature in terms of drug use, clinical diagnosis, and concomitant disease, and these patients do not have any clinical signs and symptoms. Conclusion(s): In conclusion, HCQ is considered to be an effective treatment for Covid19 especially the early phase of the illness. Regarding the potential QTc prolongation, HCQ has become a potential risk factor for ventricular fibrillation and death. As a result, it was concluded that during HCQ treatment applied in Covid19 treatment, QTc prolongation may occur, antipsychotics may worsen this side effect, and dose adjustment is required [1-5]. No conflict of interestCopyright © 2020