Das Herz und die Psyche

Zusammenfassung

Im Vergleich zur Normalbevölkerung haben Patienten mit psychiatrischen Erkrankungen eine höhere kardiale Mortalität. Einerseits besteht ein direkter kausaler Zusammenhang über hormonelle und hämatologische Prozesse, andererseits ist das erhöhte kardiovaskuläre Risiko zu einem Großteil auch auf die vermehrte Anwendung von psychotropen Substanzen zurückzuführen. Je nach Substanzgruppe beeinflussen Psychotropika in unterschiedlichem Ausmaß Repolarisation und Depolarisation sowie Blutdruck und Herzfrequenzverhalten. Der QTc-Verlängerung kommt dabei der größte Stellenwert zu, wobei sich die klinische Relevanz meist durch das Zusammenspiel unterschiedlicher Risikofaktoren ergibt. Diese und die unterschiedlichen Nebenwirkungsprofile von Psychopharmaka sowie Empfehlungen zum klinischen Vorgehen werden im nachfolgenden Beitrag überblicksmäßig erläutert.

Daneben wird dem Leser der Link zwischen Herz und Psyche anhand einzelner psychiatrischer Krankheitsbilder, die speziell Kinder und Jugendliche betreffen, näher gebracht.

Summary

In contrast to normal population, there is higher cardiac mortality in psychiatric patients. On the one hand there is evidence of haematological and hormonal abnormalities in psychiatric disorders responsible for increased cardiovascular risk, on the other hand the use of psychotropic drugs has been associated with increased cardiac death. Cardiac side effects depend on substance group and include changes of depolarisation, repolarisation as well as alterations in heart rate and blood pressure. Among these, prolongation of QTc interval is the most important, its clinical significance however is mostly linked to coexistence of one or more risk factors. The extent of cardiac side effects related to the use of antipsychotic agents, the impact of proven risk factors and clinical approach are discussed in this article.

Moreover the link between heart and psyche is illustrated by various psychiatric disorders affecting especially children and adolescents.

Schlüsselwörter

Psychopharmaka - kardiovaskuläres Risiko - psychiatrische Erkrankung

Keywords

Psychotropic - cardiovascular risk - mental disorder

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