| Summary: | 博士 === 慈濟大學 === 醫學研究所 === 98 === Background: Antipsychotics have been approved to increase the risk of proarrythmia. In addition to antipsychotics, there are two electromagnetic treatments, electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), used in clinical practices of psychiatry. The impacts of psychotic symptoms, ECT and rTMS on the cardiac autonomic function in schizophrenic patients who often receiving antipsychotics are worthy for more attention.
Methods: In Study A, 51 chronic schizophrenic patients all received the same group of antipsychotics. Stressful positive psychotic symptoms were assessed and 5-min electrocardiography was recorded for further heart rate variability (HRV) analysis. In Study B, 13 female schizophrenic patients who were scheduled for ECT were enrolled. In ECT sessions, 5-min electrocardiography was recorded before and after the ECT. In control sessions, the second 5-min electrocardiography was recorded during 6~10th min after the administration of anesthesia. In Study C, 8 chronic schizophrenic patients with auditory hallucinations were enrolled and their Clinical Global Impression at baseline and at the end of the rTMS trial and scored. The severity of auditory hallucination was assessed using the Hallucination Change Scale at baseline, the end of rTMS trial, one week later, and one month later. We also recorded 5-min electrocardiography before and after rTMS and sham stimulations. Procedures of HRV analyses in Study B and C were the same with those in Study A.
Results: Results of Study A showed that positive psychotic symptoms were not significantly associated with the cardiac autonomic function. In Study B, we approved that thiamylal, the anesthetic agent commonly used in ECT, may suppress sympathetic modulation till the end of an ECT session. The electric shock may result in suppressed vagal control and escalated sympathetic modulation till the end of an ECT treatment. Taken together, at the end of an ECT session, sympathetic modulation may show no significant change but vagal control may be suppressed. The results of Study C showed that rTMS had partial efficacy on AHs in schizophrenia, and rTMS was also well-tolerated. Regarding to the cardiac autonomic function, sham stimulations increased vagal activity and decreased sympathetic modulation. After rTMS stimulations, vagal activity and sympathetic modulation sympathetic both increased. Taken together, magnetic stimulations may have significant elevation on sympathetic modulation without influence on vagal activity.
Conclusions: Positive psychotic symptoms may not influence the cardiac autonomic function. ECT and rTMS may not only treat psychotic symptoms, but also have some impacts on the cardiac autonomic function.
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