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Sex difference in QTc prolongation in chronic institutionalized patients with schizophrenia on long-term treatment with typical and atypical antipsychotics

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Abstract

Objective

The rate-corrected electrocardiographic QT (QTc) interval may significantly increase in patients with schizophrenia taking antipsychotics. The objective of this naturalistic study was to assess the prevalence of prolonged QTc interval in a large population of inpatients with chronic schizophrenia and to explore QTc relationship with demographic variables and prescribed treatments.

Materials and methods

Electrocardiograms were obtained from age- and sex-matched 456 controls and 1,006 inpatients with schizophrenia (male/female = 689/317) taking antipsychotics. QTc prolongation was defined as a mean value of two standard deviations above the controls. The adjusted relative risk was calculated using logistic regression analysis.

Results

QTc prolongation was present in 45 (4.5%) of 1,006 patients overall. Fewer men (3.2%, 22 of 689) than women (7.3%, 23 of 317) displayed QTc prolongation (p < 0.004). Moreover, QTc intervals were shorter in male (391 ± 31 ms) than female subjects (400 ± 37 ms) (p < 0.001). Clozapine was found to produce a longer QTc intervals compared to risperidone and typical antipsychotics. Furthermore, multiple regression analysis showed that significant predictors for QTc prolongation were comorbid cardiovascular disease, antipsychotic types, sex, and age (all p < 0.01).

Conclusion

Our present findings suggest that there are sex differences in the prevalence of QTc prolongation and QTc lengthening in schizophrenia. Antipsychotic types are risk factors for QTc prolongation, and risks are substantially higher for clozapine.

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Acknowledgments

This study was funded by the Stanley Medical Research Institute (03T-459 and 05T-726) and the United States National Institute of Health (K05-DA0454, P50-DA18827, and U01-MH79639).

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Authors and Affiliations

  1. Beijing HuiLongGuan Hospital, Beijing, 100096, People’s Republic of China

    Fu De Yang, Xiang Qun Wang, Xiu Ping Liu, Ke Xin Zhao, Wei Hong Fu, Xue Ru Hao, Xing Li Zhang, Guo Shu Huang, Sheng Cai Qu & Jing Shen Bai

  2. Centre for Translational Neuroscience, School of Health Sciences, University of Wollongong, Wollongong, Australia

    Xu Feng Huang

  3. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Thomas R. Kosten & Xiang Yang Zhang

  4. VA Medical Center, Research Building 110, Room 229, 2002 Holcombe Boulevard, Houston, TX, 77030, USA

    Thomas R. Kosten

  5. VA Medical Center, Research Building 109, Room 130, 2002 Holcombe Boulevard, Houston, TX, 77030, USA

    Xiang Yang Zhang

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  1. Fu De Yang
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  2. Xiang Qun Wang
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  11. Xu Feng Huang
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Correspondence to Fu De Yang, Thomas R. Kosten or Xiang Yang Zhang.

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Yang, F.D., Wang, X.Q., Liu, X.P. et al. Sex difference in QTc prolongation in chronic institutionalized patients with schizophrenia on long-term treatment with typical and atypical antipsychotics. Psychopharmacology 216, 9–16 (2011). https://doi.org/10.1007/s00213-011-2188-5

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  • DOI: https://doi.org/10.1007/s00213-011-2188-5

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